Client Intake Form

“Astrocartography” Astrology Consultation
Return Client Form

Thank you for choosing to have an Astrocartography Astrology Consultation with Colleáyn Klaibourne.

This Form is for Returning Client Astrology Consults with Colleayn

If you haven’t had an Astrology Session with Colleayn before,
fill out this form so I can get your birth information.

* Each family member needs to fill out a separate intake form.

These sessions are done via Zoom.

**Information to send to Colleáyn at least 4 Days before your session:**

I look forward to working with you.

Client Intake Form

Each field needs to be filled out completely in order for this form
to be successfully submitted to Colleayn.

Today's Date *

Name *

First

Last

Address *

Address Line 1

City

State

Zip Code

Cell Phone *

Home Phone

E-mail *

Date of Birth. *

Age *

Gender *

Female
Male

Relationship Status *

Occupation / Vocation. If Retired, Previous Occupation/ Vocation *

The reason I ask for occupation is in case I’m seeing different work, hobbies, education, etc. that would be good for you to explore.

Hobbies & Interests *

~

Questions for your Session

This will give me an idea of your topic of interest and questions before your session so I can prepare and analyze your charts ahead of time. We will see how much we can cover during our session together because no matter how much time we have together, it never feels like enough!

What are your top 3 things you would like me to focus on or talk about during our session in relation to your move or relocation? Please describe your reason for seeking an astrocartography consultation at this time. *

Is there a place you are thinking of moving or up to 3 places you want me to look at? I will bring up the maps for these areas on your astrocartography charts. *

Have you noticed any places that you have really enjoyed living, visiting or vacationing at that were great experiences and you felt really good? Please share those. *

Are there any places that you have lived, visited or vacationed at that you had difficult experiences, you didn't connect with at all, or that you would prefer not to go back to if you didn't need to? Please share those. *

Is there a time frame you are looking at for your move/relocation that you would like me to prepare for? *

If there are important timelines or dates involved to your question, please list them. I look at charts of the dates for more information to guide you. *

What challenges/issues, stresses or concerns are you currently experiencing around this or in general? *

Please share anything that will help prepare for our consultation or that you would like me to be aware of. *

The more information you share, the deeper I can look at what is happening.

~

How did you learn about my work? How or by whom were you referred? *

I have read & agree to the Notice & Client Bill of Rights *

I have read & agree to the Notice & Client Bill of Rights

I have read & agree to the Terms of Service & Privacy Policy ckgalleria.com collecting and storing my data from this form. *

I have read & agree to the Terms of Service & Privacy Policy and consent to ckgalleria.com collecting and storing my data from this form.

I am providing my electronic signature approving all the information entered. *

I am providing my electronic signature approving all the information entered. Electronic Signature Definition.

Type in Your Full Name *

Thank you.

Phone

Client Intake Form

Thank you for choosing to have an Astrocartography Astrology Consultation with Colleáyn Klaibourne.

This Form is for Returning Client Astrology Consults with Colleayn

* Each family member needs to fill out a separate intake form.

These sessions are done via Zoom.

**Information to send to Colleáyn at least 4 Days before your session:**

I look forward to working with you.

Client Intake Form

Each field needs to be filled out completely in order for this form
to be successfully submitted to Colleayn.

~

Questions for your Session

~

Follow Me on Instagram @CKGalleria

ckgalleria

BLOG LISTS

Links

Cart

We use cookies on this site to enhance your user experience.
For a complete overview of the cookies used, see our cookie policy.

Client Intake Form

Thank you for choosing to have an Astrocartography Astrology Consultation with Colleáyn Klaibourne.

This Form is for Returning Client Astrology Consults with Colleayn

* Each family member needs to fill out a separate intake form.

These sessions are done via Zoom.

Information to send to Colleáyn at least 4 Days before your session:

I look forward to working with you.

Client Intake Form

Each field needs to be filled out completely in order for this formto be successfully submitted to Colleayn.

~

Questions for your Session

~

Follow Me on Instagram @CKGalleria

ckgalleria

BLOG LISTS

Links

Cart

We use cookies on this site to enhance your user experience.For a complete overview of the cookies used, see our cookie policy.

Review Cart

**Information to send to Colleáyn at least 4 Days before your session:**

Each field needs to be filled out completely in order for this form
to be successfully submitted to Colleayn.

We use cookies on this site to enhance your user experience.
For a complete overview of the cookies used, see our cookie policy.