Vedic Rectification Form
Appointment with Dr Andrew Foss
The following information is required for the rectification of your birth time. This does not necessarily include a Jyotish (Vedic astrology) reading with Dr Andrew Foss. If the information given is thorough and the work involved is not great, then some discount on the reading fee will be extended. After receipt of your information, please give about one week for making and initial study of the chart. In case we need further information, we will get back to you on this. 
Please fill this form and mail to andrew@vedicsoftware.com 

Please note that the Rectification Fee is for a rectified time only and up to 30 minutes discussion about it. If you would like to extend that session an extra hour consultation fee ($215) or half-hour consultation fee ($108) has to be paid for answering of questions. If booking a consultation please fill the form for that.

Payment method
(1)	Please pay at the website vedicsoftware.com (click link 'Pay for Consultation'
(2)	OR  You can pay directly at www.PayPal.com to shrisource@gmail.com 

DO NOT send your credit card number. It is a security risk to transmit this over email. 

Name: 
Address: 		
Street:	Phone:	
City: 	Mobile:	
State: 	E-Mail:	
Zip: 	Skype:	
Country:		
Name Information
Reference:	For Vedic Numerology Calculations: Do not write in box	
Have you had a reading with Andrew Foss before?		
		
Name at Birth:		
		
Name changes if any with date:		
		
Pet Names or other Alias:		
Birth Data
I am using    [ ] Month/Day/Year	[ ] Day/Month/Year 	for all dates below

Date of Birth:

Time of Birth: 
HH.MM.SS [AM/PM]
Time Zone: (if known)

Place of Birth:

State or County of Birth:

Country of Birth:

Source of birth data:

Please give the source of the birth data to check the accuracy.

Data Verification procedure
Some events of life are required to verify the birth data given. These life events can be anything of some significance in your life like birth of brothers and sisters (younger), school admission dates, leaving home, death of a loved one like parent or sibling, marriage dates, child birth, ill-health dates or surgery or anything that has made some impact in your life. We ask for at least three events but if you recall more dates, please include them after the first three. 

Why are we asking for this? A human being is born every minute and we do not know if the chart being seen is that of yours or another human being born a minute or two apart. The information you provide shall help us in ascertaining the exact birth time. We respect your privacy and shall not share this information with anyone or for any purpose what-so-ever. 

Yourself: Please describe yourself, your character, interests, skills, important preferences and persistent experiences or issues.

Intimate relationships lasting more than one year as far as possible. The Start would be when it became intimate and the End, if applicable, would be when final separation took place.

Start Date		End date		Marriage? 	Notes

#1

#2

#3

#4

#5

Parents: Please give the birth and, if applicable, death dates of mother and father and a brief paragraph on each – your relationship, their career, etc. Use space at the end of this document if needed. If you lost contact with a parent, please mention when this occurred. If fostered or adopted, please mention this and when this started.

Mother

Father

Siblings: Please list your siblings from the oldest to the youngest

	Birth Date	Gender	Relationship – Good, close, difficult, distant, etc.
#1

#2

#3

#4

#5

Children: Please list your children from the oldest to the youngest

	Birth Date	Gender	Relationship – Good, close, difficult, distant, etc.
#1

#2

#3

#4

#5

Health: Please mention major surgeries and accidents in the events section below. Here,  please describe any longer term conditions and when this condition was diagnosed and whether you have recovered. You can mention any other points about your health you think are important. Use extra space at the end if needed.

Important events not listed above:

Event#1: Date / Time/Description

Event#2: Date / Time/Description

Event#3: Date / Time/Description

Event#4: Date / Time/Description

Event#5: Date / Time/Description

Career particularly major steps forward and setbacks with dates

Other: Please mention any other matters that you think might be helpful about your life: