Consultation Form	

Contact details
consult@vijayajyoti.com
skype id vijaya19
phone + 44 7811171586

The following information is required for a Jyotish (Vedic astrology). 
Please give me about one week for making and initial study of the chart after which I will inform you of the appointment date. In case we need further information, I will get back to you on this. 
Please fill this form and mail to consult@vijayajyoti.com 

Payment Method

DO NOT send your credit card number. It is a security risk to transmit this over email. We will e-mail an invoice to enable payment through the net based on information provided. 

Name: 

Address: 
	
Street: 
	
City: 
	Mobile: 	
Postcode: 
	Email: 	
Country: 
	Skype: 	

Name Information
Have you had a vedic consultation with me before? 	
	
Name at Birth: 

Name changes
(if any) with date: 
	
Birth Data

Date of Birth: 
In Format: Date/Month/Year

Time of Birth:  

Place of Birth: 

Country of Birth: 

Source of birth data: 
(Please mention the source of the birth data to check the accuracy – i,e from a birth certificate, or record from a book, etc.)

Data Verification procedure
Can you please list three significant events in your life, like your date when you left your country of birth, date of marriage, calamity or ill health of siblings, birth of children or your own major ill health? We are asking this so that if necessary we need to adjust your recorded time to the second or minute. Please provide event name and date and month and year, if possible.  

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2.

3.

Consultation

After selecting a type of consultation, can you please list the questions you would like me to address? 

Please indicate the following:

Are you following any spiritual practices of any faith? 

Would you consider using practices such as pranayama, meditation, yoga or mantras for remedies or you would prefer using gemstones as remedies? 

All information provided herein, is absolutely confidential. Om Tat Sat