Appointment

Client Intake Form – Tranform Your Life by Dr. Uma

This space is for clarity, not judgment. I’m here to help you decode your journey through astrological, intuitive insight. Fill in the details below and I’ll personally guide you to the right service.

🕊️ All responses are strictly confidential.

🔹 SECTION 1: Personal Details

Full Name

Email Address

WhatsApp Number (with country code)

Preferred Language:

HindiEnglishBoth

🔹 SECTION 2: Birth Details

Date of Birth

Time of Birth

Place of Birth

🔹 SECTION 3: Service Selection

Which service are you interested in?

Know Your Chart – Kundli DecodingAsk Me One QuestionRelationship Karma & Compatibility ReadingNot Sure / Need Guidance

🔹 SECTION 4: Your Current Concern

What is your current challenge, question, or inner confusion?

Have you explored astrology or meditation before?

Yes, deeplySomewhatNo, this is my first time

Are you open to mantras, journaling, or rituals for self growth?

YesNoCurious but unsure

🔹 SECTION 5: Scheduling (Only for Zoom-Based Sessions)

Preferred Days/Time for Zoom Call (if applicable)

🔹 SECTION 6: Final Thoughts

Is there anything else you’d like to share with me before we begin?