Your name, first name (optional)

    Your place of birth: City, if your city is small, indicate the major city closest to your place of birth

    Please, indicate the year, month, day and time (if known) of your birth

    Your illnesses and injuries (if any) and their dates

    Are you married?

    If yes, please indicate the date of the wedding, the decision to live together, etc. - it's up to you to indicate a significant date

    Is it your first marriage?

    If several marriages, please indicate the date of each marriage (marriage and divorce, or the date of living together and its end) Also, indicate the nature of the marriage (official registration, common-law union, etc.)

    Do you have children? Dates of theirs birth

    When did you start to practice your main profession?

    Your Chronic illnesses (if have ones)

    Have you had any illnesses, or have you undergone surgeries or accidents that pose a high risk to your life? Dates of these events

    Place of your current residence

    Have you emigrated to another country? If yes, the date of emigration and the country

    Do you practice astrology yourself? How familiar are you with astrological terms?

    Is this your first astrological consultation?

    What is the main purpose of your consultation, what subject are you most interested in at this time?

    Your E-mail

    Your Phone number