Appointment

Client Intake Form – Heal Your Life by Dr. Uma

This space is for clarity, not judgment. I’m here to help you decode your journey through astrological, intuitive, and healing-based 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 QuestionSoul Healing Journey – 21 Days Alignment SupportRelationship Karma & Compatibility ReadingNot Sure / Need Guidance

🔹 SECTION 4: Your Current Concern

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

Have you explored astrology, healing, or meditation before?

Yes, deeplySomewhatNo, this is my first time

Are you open to mantras, journaling, or rituals for healing?

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?