Kira's Astrology

Contact Request: Initial Information

Individual consultations are available by mail or by phone.

If you are seriously considering a consultation, please fill out and submit the following form. This does NOT obligate you in any way: rather I will contact you to confirm your interest and schedule an appointment. (Sorry, but incomplete forms will be discarded.)

You must be at least 18 years of age.

Full Name:

Complete Mailing Address:

Phone Number:

E-Mail Address:

Birth Date: Month/Day/Year

Birth Time: Hour:Min AM/PM

Birth Place (City, State, Country, etc.):

Which consultation service(s) you are interested in:
In-Depth, One Subject
Specific Issue
Weight Control
Child's Reading

Any additional notes or questions:

Kira Ivory, Astrological Consultant

Copyright © 1996-2004 Kira Ivory. All rights reserved.