CLIENT  DATA  FORM

Last Name

   

First Name

Gender

Male  Female

Birth Date

Birth Time

24-Hour Format

Accuracy of Time

Birth Place

Education

Occupation

Physical Features

Habits

Religion

Marital Status

Orientation

Matrimony

Date of Marriage

Date of Divorce

Biological Children

Birth Date & Gender

Spouse(s)

Birth Date & Gender

Hospitalization

Date of Entry & Cause

Date of Release

Accidents/Operations

Date & Type

Employment

Date of Entry & Type

Date of Termination

Hobbies/Interests

     

Selected Program

Duration

Report

 

Present Problem

Additional Notes

E-mail Address

Phone

Date of Entry

Fax

Postal Address

         

  • Entering incorrect information effects the astrological profile used in analysis, and causes erroneous results. Therefore, please do not give false or estimated information. In case of uncertainty, you may put a question mark into the field, or press the space key.

  • First and last names are required only for archiving purposes. You may use a nickname if you prefer, and it will not effect the results.

  • E-mail address is necessary for easy communication, particularly for distant clients.

  • Please do not press "Submit" button more than once. If more than one form is received from the same client, the last dated one will be taken into account.

  • Client forms are evaluated after the appropriate payment. Selected program field entries determine the type of report, and conveyance. For consultation meetings, please arrange an appointment by phone, in advance.

  • Those who wish to fill blank forms for the same purpose, may download Word document format or rich text format or plain text format file, fill it out, and send it by fax or post.

  • For the convenience of the client, consultation fees are listed below:

PROGRAM DURATION
ONE HOUR TWO HOURS THREE HOURS
Radix Analysis

A

non-curative $ 40 $ 60 $ 90
+ medical aid $ 80 $ 120 $ 180
Progressive Analysis

B

3 MONTHS $ 60 $ 100 $ 140
6 MONTHS $ 80 $ 120 $ 160
1 YEAR $ 120 $ 160 $ 200
2 YEARS $ 200 $ 240 $ 280
Radix Synastry

C

non-curative $ 60 $ 90 $ 135
+ medical aid $ 120 $ 180 $ 270
Progressive Synastry

D

3 MONTHS $ 90 $ 150 $ 210
6 MONTHS $ 120 $ 180 $ 240
1 YEAR $ 180 $ 240 $ 300
2 YEARS $ 300 $ 360 $ 420

Copyright © 2004-2008 Haluk Akcam. All rights reserved.

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