"One Question" Session Information
 


Please fill out and click SUBMIT FORM at bottom of page.

All information will remain completely confidential.
  * required fields

Order Information:     
 
Your Name * Country
Address Email *
City * Time Zone
State (or none) * Telephone *
Zip/ Postal Code Phone Type*    Daytime      Evening       Cell
I am a   New Client    Returning Client    

   Person 1 Chart Information:
 
  Name on Chart 
  Birth Date  
  Birth City  
  Birth State  
  Birth Country  
  Time of birth      a.m.      p.m.   
  Time of birth is from:  
 		 Birth certificate (preferred if available)
 Memory or Estimate
 Unknown or unavailable 
 
Person 2 Chart Information (if relevant):
 
  Other Name on Chart 
  Other Birth Date  
  Other Birth City  
  Other Birth State  
  Other Birth Country  
  Other Time of birth      a.m.      p.m.   
  Other Time of birth
is from:  
 		 Birth certificate (preferred if available)
 Memory or Estimate
 Unknown or unavailable 
 

 Your Question:  

 
  Helena typically speaks to clients Monday - Friday from 9 a.m. - 5 p.m. US Pacific time.
Please give us five good dates & times for your session:
    1.  Month/Day/Time:     a.m.   p.m.  
 
 2.  Month/Day/Time:     a.m.   p.m.   

 3.  Month/Day/Time:     a.m.   p.m.  
 
 4.  Month/Day/Time:     a.m.   p.m.   

 5.  Month/Day/Time:     a.m.   p.m.   
     We will make every effort to schedule your session as quickly as possible consistent with sufficiently good Universal stars and to confirm one of the dates and times you have listed above. Otherwise, we will email you some alternate dates and times. You will receive call-in instructions when your appointment is confirmed.

Click "Submit Form" only ONCE - otherwise you will send multiple forms.
Please be patient and allow time for form to complete the submission process.  : )
            Problems with this form?
 

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