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Client Intake Form
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1.  Your exact time of birth, date of birth and place of birth

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2. Current marital status (add wedding date(s) if available)

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3. Whether you have kids and when they were born (month + year is fine)

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4. If your parents are alive

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5. If you have brothers / sisters (indicate if older / younger)

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6. If you have any chronic / serious diseases (please list)

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7. Education (area) and current occupation

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8. Dates of any significant personal life events (month + year is fine)

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9. What your possible questions are (relationships, finances and career, kids, relocation or travel, health, etc.)

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I confirm that my provided birth data is accurate and I understand the consultation disclaimer.  I agree with Terms & Conditions of this service published on the website. 
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