Medical Astrology Questionnaire

Thank you for booking your medical astrology reading with me. Please fill out the below form ASAP. I know some of these questions may required a few days to complete. I will need the completed form back at least a week prior to our appointment.

Name

First Name

Last Name

Email

Birthdate

MM

DD

YYYY

Birth Time

Birth Location

List any conditions that you are concerned about and the date that they began

if no diagnosis has been rendered as of yet describe the symptoms.

Please list any dates or time periods when changes to the above conditions occurred

If there have been any treatments or surgeries please list those dates and the results

Please Provide any other information you feel applies.

Please provide a 24 hour diet diary for everything that you ate in the past 24 hours.

Include all medications and supplements

I understand that Julie Larson is not a Doctor and is not providing medical advice. This reading is given for entertainment and enrichment purposes only.

Yes

Medical Astrology Questionnaire

Thank you! I’m excited to dig into your chart and look forward to our call!

Please reach out if you have additional questions…

Subscribe