Submit Birth Info for an Astrology Reading
Please use this form to submit birth information for our appointment.
If you're submitting information for more than one person, please submit a separate web form for each person and put your name in the Comments each time. You'll need to refresh the page in your browser (usually press F5) between submissions.
If a birth time is unknown, please use 12:00 PM.
Please enter any helpful information in the Comments section, such as time zone, daylight savings, or county (for duplicate town names in the same state), etc.
If you have a problem with the web form, please send a message through the Contact Form on the Connect page.
BIRTH INFO FORM
YOUR BIRTH INFO WILL BE KEPT PRIVATE
I never send spam. Please let me know in the comments field above if you DO NOT want your email address added to the list that I infrequently notify about special events and offers.