Molly's Astrology

To request a surgery date consult, please fill out the requested information and submit this form. I will use this information to calculate your astrological chart and find the best available date for your surgery or other medical or dental procedure.

Please check with the surgeon's office before you submit your info to me, to find out the details and constraints of their schedule. I do not need detailed information about the surgery. I do need detailed information about the dates the surgeon is booking appointments. (Go ahead and pester the office staff!)

I also need to know about the limitations of your schedule. Please be precise. Not "I am traveling Memorial Day weekend." Please give me the date you leave and the date you return.

When you submit this form, I will receive an e-mail. You will also receive a copy. Please feel free to follow up with a phone call to (434) 933-2475. I do my best to answer within 24 hours.

Your name

Your e-mail address

Patient's date of birth (including year)

IMPORTANT: SPELL the month. (12/4 can mean December 4 or April 12.)

Time of birth

(Make sure you indicate a.m. or p.m.)

City/State of birth, county or country if applicable

In what city will the surgery take place?

10 words or less please: What's the general nature of the surgery? What part of the body does it involve?

This is a cosmetic surgery

Is it medically urgent? How soon must it be done? Is it elective/open ended?

Please list the days of the week your surgeon has appointments available. Or simply list the dates I should consider.

Earliest opening on the surgeon's schedule

Occasionally I see stress patterns in a chart that last several months to a year or more. If one of these were to show up, could it be put off for a while? How far out in time should I look?

Please list any dates in your range that are unavailable or off the table for any reason.

Payment Please send me a Paypal invoice. I have made payment via Paypal. Please send me your mailing address so I can send a check. I am requesting a fee waiver.

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