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Personalized Astrology Intake Form

Personalized Astrology Intake Form

This is a private, limited-capacity 3-month container where we apply your birth chart to your real life in real time. Because this experience is deeply personalized and custom-tailored to your unique chart, please answer the questions below thoughtfully so I can fully prepare for our work together.

Your Name(Required)

First Last

How Can We Reach You?

Your Email Address(Required)

Email Address Confirm Email Address

Your Phone(Required)

Have we worked together before?(Required)

Astrology Reading

Women's Circle

Energy Healing (Reiki, Crystal Healing)

Workshop/Event

Have you had a birth chart reading with Laurel before?

Yes, in the last 30 days

Yes, but it's been longer than 30 days

No, but I've had a reading elsewhere

No, this is my first time getting a reading

Birth Chart Information

Date of Birth(Required)

MM slash DD slash YYYY

Birth Time(Required)

Hours

:

Minutes

AM/PM

Birth City, Province/State, Country(Required)

What is currently feeling the most challenging, overwhelming, or draining in your life right now?(Required)

Select your preferred payment structure:(Required)

Monthly Plan ($225 per month for 3 months)

Paid in Full ($675 upfront)

Nature of the Container & Personal Responsibility(Required)

I understand that the Personalized Astrology 3-month container is an exploratory program based on applied astrology, cyclical tracking, and personalized guidance. I acknowledge that Laurel Berube is a holistic practitioner, not a licensed clinical therapist, medical professional, or life coach. I accept full personal responsibility for my own physical, emotional, and mental well-being and processing throughout this 3-month journey.

Financial Commitment & Cancellation Policy(Required)

I understand the financial terms of this 3-month container. If I am on the monthly payment plan, processed installments are strictly non-refundable, and I must provide notice before my next billing cycle to cancel future months. If I paid in full, the current month in progress is non-refundable, and any unused months will be refunded minus a $25 administrative fee. I acknowledge that any applied reading credits are completely non-refundable.

Reading Credit Eligibility(Required)

I understand that to qualify for the individual reading credit deduction, I must have completed a standalone individual Astrology Reading with Crystal Moon Healing within the one (1) month immediately prior to my container start date. Readings done further out or with other astrologers are not eligible for a credit.

Intellectual Property Protection(Required)

I agree that all emails, reports, and proprietary materials provided to me during these 3 months are the intellectual property of Crystal Moon Healing. They are granted to me for single, personal use only, and I agree not to copy, share, redistribute, or use them for commercial or professional purposes.

Live Zoom/In Person Sessions Rescheduling Boundary(Required)

I understand that my container includes live Zoom or In Person sessions. I agree to provide at least 24 hours' notice if I need to reschedule a live session. I acknowledge that sessions canceled or missed with less than 24 hours' notice are entirely forfeited and cannot be credited or made up.

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