Vedic Reading Form - Mind Yourself Ayurveda

Vedic Astrology Intake Form

Vedic astrology is deeply precise — each planetary placement depends on the exact time, date, and place you were born. The more accurate your information, the more meaningful and aligned your reading will be.

Name

Phone Number

Present City & State of Residence

Birth Day, Birth Month, Birth Year

Birth Time

Accuracy of birth time and source (birth certificate, Mother, etc.)?

Birth Place

faith/views of Birth

Birth Sex

Have you had a Vedic Astrology consultation before (if so, list remedies you have done or are presently doing, including gemstones and mantras)?

Purpose of reading/what would you like to know (You are welcome to include more than less to be able to get the most out of your reading):

Additional chart information that may be needed (spouse/child/marriage date, disease diagnosis, treatment etc. according to the areas of focus):

Briefly describe your religious faith/views or spiritual practice (in case remedial measures are prescribed):

Please detail who referred you to Kamala’s services, or how you heard about Mind Yourself Ayurveda’s services?

Comment or Message