INTAKE FORM
DAYDREAMING @ Temple Of  
Julia Arredondo + Chad Kouri  on view April 28th  - June 3rd, 2023 at Roots & Culture Chicago.

astrology, hypnosis, daydreaming, divination available:

Wed. May 10 + Sat. May 20 + Fri. June 2

To get the best out of your experience, please fill out this brief questionnaire at your earliest convenience. Ideally, at the time of booking or at least 12hrs before our visit.
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PART 1 - About You
Email *
Same one you will use for our appointment.
Name *
 Pronouns
Your Birthday *
MM
/
DD
/
YYYY
Birthtime
We use this to cast your natal chart and is important for confirming your rising sign.
Time
:
How accurate is this time?
Please note, although we can pull your chart without a solid time, you will get the best results with an accurate hour and minute; So it's worth searching for it if you can.
What (city / state / country) were you born? *
Used to cast your natal chart.
PART 2 - About our session
Your session is on *
These private sessions means we have the whole gallery to ourselves. 
**Public gallery hours are great for walk ups and short reads between 12-6pm on Friday.
What do you want to get our of this session?
The more details you provide, the better I can prepare ahead.
How will we spend out time together?
Are there any boundaries or triggers you'd like for us to be mindful of?
Only share what you feel comfortable, it can be surface level.
When you're doing you best, where and how do you feel it?
What comes to mind when you think of a peaceful place? 
When you close your eyes to imagine something, how do you get information?
Please read and sign off on to the following
By submitting this intake form you understand the Terms & Agreements regarding hypnosis and the statements below:
Thanks so much-- See you at our session!
Roots & Culture is located at 1034 N Milwaukee Ave
I'll meet you at the door during your appointment time. 

Reach out via email for questions or help: info@kpfkpf.com
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