Intake Form

Please be so kind as to complete the following form. Understanding your interests will confirm that we are a good match and help determine the best support for you. Looking forward to being of service.
Client Release and Disclaimer

I hereby request of you, Simon Basner, to inform me of the planetary forces and energies present on the date of my birth and at other times in my life. I affirm that the date and time of my birth is true to the best of my knowledge. In sharing this information with me, I understand you obtained it from charts constructed by you, from your own learning and experience, and from books and almanacs related to Astrology. I understand that the information you share with me is for educational purposes, and makes no claims with regards to fortune telling or psychic phenomena. I understand that reliance on information received during this or any future consultation we share is solely my own decision. I understand and accept that all information provided is not intended to take the place of the same delivered by other professionals, such as accountants, attorneys, financial advisors, medical doctors, psychiatrists, psychologists or other therapists.

Thank you.

All consultations are treated as strictly confidential. It is completely recognized that your unique personal life is fully honored. Please know all that is shared will be kept safely and securely confidential.

Sincerely,
Simon Basner
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