Carl L Buchheit, PhD
Revealing the Family Conscience
Please complete and send this form at least 72 hours prior to your constellation appointment.
The following questions are intended as a guide to help gather important information about your family. Please fill in the boxes that are appropriate with regards to your family of origin (siblings, parents, aunts, uncles, grandparents, and great-grandparents) and your present family (any spouse/partner, children, and any previous spouses or partners). Your information will be kept secure and confidential.