Pre-Session Form

Your Contact Information

Name*

First Last

Email*

Order #*

Get this from your order confirmation email. #xxxxx.

Phone

City State / Province / Region Country

Your Time Zone*

Time Zone for your call with Helena

Company

Interests

Your Birth Date*

Your Birth Location*

City State / Province / Region Country

Your Birth Time (if known)

:

Your Birth Time is:*

Name #2

First Last

Birth Date #2

Birth Location #2

City State / Province / Region Country

Birth Time #2

:

Birth Time #2 is:

Date you met (if applicable)

Date you became lovers (if applicable)

Date you married (if applicable)

Use this space to submit any additional dates. Keep your question list handy for your session, you don't need to sent your questions in advance.

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