In order to receive a gemstone recommendation

    you must complete the following form.

   First name
   L:ast Name

    address 1

    address 2

       Town 3

  County/State 4


   Phone Number


   Date of Birth


   Time of birth

   Place of Birth

   Is this time from a birth certificate or hospital tick if yes

   Is this time from a relationl mother etc l tick if yes

   To within how many minutes do you think this time is accurate

   Do you have any particular reason for wanting a Gem recommendation?
   Please write in box.