Birth Data Form Birth Data Fill in one form for each person or entity to be charted. Email* PhoneWhat reading/service are you purchasing* Seize the Right Day (single or bundle) Discover Your True Self (Birth Chart) Planning Ahead Annual Forecast Starter Bundle Birth Chart & Annual Forecast Prospects for Romance Your Relationship Roadmap Compatibility Analysis Baby's First Reading Your Career (and Calling) Compass Your Travel Relocation Horizon Practical Answers for Your Pressing Questions Retracing Your Footsteps (Birth Time Finder) Star Party - Astrologically Themed Get-Together Gift Certificate Name (as it should appear on charts): First, Last (middle name or initial optional) (This does not have to be the birth name.)2nd Name (as it should appear on charts): First, Last (middle name or initial optional) (This does not have to be the birth name.)Optional 3rd Name (as it should appear on charts): First, Last (middle name or initial optional) (This does not have to be the birth name.)Date of Birth MM slash DD slash YYYY Month, day and year of birth (mm/dd/yyyy)2nd Person Date of Birth MM slash DD slash YYYY Month, day and year of birth (mm/dd/yyyy)Optional 3rd Person Date of Birth MM slash DD slash YYYY Month, day and year of birth (mm/dd/yyyy)Time of Birth : Hours Minutes AM PM AM/PM It is best to use an exact time of birth, preferably from an official record. If the birth time is unknown, leave this field blank. Sunrise will be used unless there is another suggested time frame in the Time Comments field below.2nd Person Time of Birth : Hours Minutes AM PM AM/PM It is best to use an exact time of birth, preferably from an official record. If the birth time is unknown, leave this field blank. Sunrise will be used unless there is another suggested time frame in the Time Comments field below.Optional 3rd Person Time of Birth : Hours Minutes AM PM AM/PM It is best to use an exact time of birth, preferably from an official record. If the birth time is unknown, leave this field blank. Sunrise will be used unless there is another suggested time frame in the Time Comments field below.Time Comments If the time is not known to the exact minute, describe here if the time supplied is a best guess or supply a potential range.2nd Person Time Comments If the time is not known to the exact minute, describe here if the time supplied is a best guess or supply a potential range.Optional 3rd Person Time Comments If the time is not known to the exact minute, describe here if the time supplied is a best guess or supply a potential range.Place of Birth City, County (if known), State or Nation (if not USA)2nd Person Place of Birth City, County (if known), State or Nation (if not USA)Optional 3rd Person Place of Birth City, County (if known), State or Nation (if not USA)Goal or Special Request for the ConsultationWhat the consultation should be sure to address, specific questions or situations to examine.Other CommentsAnything else your astrologer should know before contacting you to set up an appointmentEmailThis field is for validation purposes and should be left unchanged. Δ
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