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The Self Portrait | Client Intake

Welcome to The Self Portrait. This intake gives me the birth details and personal context I need to create your written reading. You do not need to know anything about astrology. Your PDF will arrive within 5 to 7 business days after I receive your completed intake.

Full Name

Email Used at Check Out

Date of Birth

Birth Time

Exact Birth City, State or Region, and Country

Where would you most like clarity?

What two or three questions do you wan tthis reading to address?

What Decision are you facing right now?

Where do you suspect you may be settling?

I understand that The Self Portrait is a reflective coaching tool, not a prediction or a substitute for professional advice. I remain responsible for my decisions.

Yes

The Self Portrait | Client Intake

Full Name

Email Used at Check Out

Date of Birth

Birth Time

Birth Time

Exact Birth City, State or Region, and Country

Where would you most like clarity?

What two or three questions do you wan tthis reading to address?

What Decision are you facing right now?

Where do you suspect you may be settling?

I understand that The Self Portrait is a reflective coaching tool, not a prediction or a substitute for professional advice. I remain responsible for my decisions.

Payment