Deb Rollings

Astrology Booking Form

Please do everything you can to find
your accurate birth time.
It will make a big difference.

Your Booking Form will be emailed to me (Deb) only.
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First Name

Family Name

Are you Are you Male Female

Your Email Address

Your Phone Number

Mail: PO Box OR Street Number & Name

Mail: Suburb / Town / City

Mail: State / Province /

Mail: Postcode / Zipcode

Mail: Country

Birth Date (month in letters, please!)

Birth Time (Important!)

BirthTime: Accuracy BirthTime: Accuracy Accurate Within 15 minutes Wider than 15 minutes Unknown

Birth Time Source (please choose)

Birth Place: Country

Birth Place: State / Province

Birth Place: Suburb / Town / City

Were you born in a hospital? Were you born in a hospital? Yes No

Birth Place: Hospital Name

Can you access Skype for your online Session? Can you access Skype for your online Session? Yes — Skype is OK No — I can't use Skype

Skype Address (for online sessions)

What do you need the most help with right now?

Like to share how you found Deb? Like to share how you found Deb? Sure (easy multiple choice pop-up) No thanks

How did you find Deb? (entirely optional) How did you find Deb? (entirely optional) Professional Referral Friend / Relative Referral Deb's Websites

Have you read it ?! Have you read it ?! Read the T&C HERE

Terms & Conditions (T&C) Terms & Conditions (T&C) I've read & agree to the T&C

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