Please be sure to complete every section below. Completing this form incorrectly or incompletely can result in forfeiting your appointment. Please complete only what is asked of you on each line. Do not, for example, state the hospital you were born in instead of Country/State/City!
If your birth time is an estimate, please offer an explanation around this in the space provided i.e.; “I was born just after sunrise” “It was around lunchtime” or if you have no idea please let us know this, too.
Thanks, and we look forward to connecting soon!