Submit Birth Info for a Relationship Reading

Please use this dual birth info form to submit the birth information for our relationship astrology appointment. If any birth time is unknown, please use 12:00 PM.

If your birth info is not included in the form, please put your name in the Comments field. 

Please enter any helpful information in the Comments section, such as time zone if known, daylight savings, or county (for duplicate town names in the same state), etc.

If you have a problem with the web form, please contact me through the Contact Form on the Connect page as soon as possible.