Request appointment -Jen Ingress

Request appointment

Please complete to request appointment. Information collected is confidential and will not be shared in any form without your written consent.

First Name

Last Name

Place of residence (city and country)

Phone Number

Astrology service(s)

Natal (Western)

Current themes (Western)

Ask a question (horary)

Synastry (Committed Relationship 2 ppl)

Astrolite (mini-reading Western or Chinese)

Natal Four Pillars/Ba'Zi (Chinese)

Four Pillars Natal & 10 yr life-cycle

Current themes-Natal-10yr (Chinese )

Feng Shui (includes Four Pillars Chinese)

I am requesting this reading for

I have permission to submit and request an astrology service if this is not for myself nor my child.

Date of Birth (YR/MM/DD)

Time of Birth

Accuracy of Birth Time

If Birth Time is approximate, please provide time range (e.g. 9:30am -11am, or before sunrise )

I do not know my birth time and am interested in an astrology birth time rectification service.

Location of birth

What is your expectation from an astrology reading?

fun

insight

curious

other

If you selected "other", please elaborate:

What is your experience receiving an astrology reading?

Overall, how would you rate your prior experience(s) with astrology?

Could you elaborate on your rating above?

Request appointment date for

Time

alternative time(s) on this date

Should your requested date not be available, please provide a few alternative dates and/or a range (e.g. first week of ....)

Time preference(s)

morning

afternoon

evening

during week

weekends

additional notes regarding time preference

Additional comments you'd like to share, or questions in regards regarding your request for an astrology service:

Terms & Conditions: Astrology reading services are unique consults presenting astrological information, may offer an alternative perspective, and is not a guarantee of the future. I understand that this is a request for an appointment only. I, soley am responsible for my own decisions /or actions and am of legal age and/or 18 years or older.

I agree to the terms & conditions above.