|
|||||||
|
|
|
|||||
|
|
|||||||
|
Free Consultation by Mail
|
|
INFORMATION FORM
|
||||
|
|
||||
| If you want to free consult us by mail, please
print, then complete this form in full and mail it to us. For our Postal Address click here .Please include a self addressed Postage paid envelope. Your request must include your Time of Birth,Place of Birth,Date of Birth. You must include a signature. |
||||
|
Please Print
|
||||
|
|
||||
|
Personal Information
|
||||
|
Last Name:
|
First Name: | |||
| Middle Name: | Date of Birth: | Time of Birth: | ||
| Place of Birth: | Home Phone (optional) | |||
|
|
||||
|
Address Information
|
||||
|
Present Address
|
Apt. # | |||
| City | Province | Postal Code | Country | |
|
Prefered Address (if you want to receive reply at different address than your present address)
|
Apt. # | |||
| City | Province | Postal Code | Country | |
|
|
||||
|
What's the Problem ? Details/History of Problem
|
||||
|
Full Details
|
||||
|
|
||||
| I am the person named above and I understand and agree to theTerms&Conditions 0f Use. I could be prosecuted under law of Country for obtaining information/consultation/services from Medical Astrology.Org by fraudulent means or under false pretences. | ||||
|
Signature
|
Date | |||
|
Revised May 22, 2005
|
||||
Copyright © 2005 Medical Astrology.Org
All rights reserved.The names of companies,services and products on Medical Astrology.Org web site are the trademarks of their respective owners. The information contained at this site may not be published, broadcast, rewritten or otherwise distributed, or stored without prior written authority of Vedic Medical Astrology.Com. All consultations are based upon analysis of the Vedic Astrology chart. Advice is given strictly as guidance which clients retain the right to use according their own free will and discernment for their particular circumstances. All final decision and actions are the sole responsibility of the client.The information contained on this site is for the sole purpose of being informative. This information is not and should not be used or relied upon as medical advice. Always seek the advice of your physician, nurse Or other qualified health care provider before you undergo any treatment or for answers to any questions you may have regarding a medical condition. Nothing contained on or provided through the service is intended to be or is to be used for medical diagnosis or treatment.