Empowerment via Astrology, Yoga, Hypnotherapy, Health Coaching and Education in the Mystical Arts

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Welcome!

Welcome!

Please fill out the form below and submit at least 48 hours before your scheduled session to make the most of our time together.

Basic Information

Name

First Last

Current Location

City State / Province / Region ZIP / Postal Code Country

Phone

Occupation

Astrological Data

Birthday

MM slash DD slash YYYY

Birth Location (City)

Birth Time

Hours

Minutes

AM/PM

How accurate is your birth time?

Accurate. Verified by my birth certificate

Close enough. From memory/Someone else told me the time

I don’t know my birth time at all

General Information

What is the primary reason for your session?

What would you ideally like to achieve with your astrological reading? List as many things as you like, even if some of those might extend beyond the scope of your primary session goals:

Have you had previous experience with:

Astrology

Meditation

Life Coaching

Hypnosis

Past Life Regression

Energy Healing

Do you have any preferred alternative or therapeutic modalities I should be aware of?

Do you have words that you either prefer to use or strongly dislike when describing larger universal spiritual concepts like “Creator/God(dess)”, “Universe”, “soul”, “Spirit Guide”, “Guardian Angel”/“Higher Self”? If so, please describe your preferences:

To ensure your comfort during our session, I want to be mindful of using constructive language that resonates with you. If you don’t feel strongly, feel free to skip this question.

Do you have any questions regarding astrology or any apprehensions about it?

(Optional) Is there anything else you would like me to know prior to your session?:

How did you hear about The Genuine Mystic?

Would you be interested in receiving occasional emails regarding client-only offers, discounts, and/or new course information in the future?

Yes

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