This is a basic intake form for readings/coaching etc
Feel free to adjust as needed.
Name
Email Address
Question 1 I would like to ask....
Question 2 I would like to ask....
Question 3 I would like to ask....
Birth time and place
Day
Month
Year
Hour
Minute
AM/PM
Select one..
AM
PM
City
State/Province
Country
Repeat birth time and place
Day
Month
Year
Hour
Minute
AM/PM
Select one..
AM
PM
City
State/Province
Country
I agree that....
I also agree that....
Thank you! Your submission has been received!
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