Question 1 of 9

1) Full Name:

Question 2 of 9

2) Email Address:

Question 3 of 9

3) Phone Number:

Question 4 of 9

4) Human Design Info (for your personalized blueprint)

Your birth data allows me to run your Human Design chart, which informs how your energy is designed to move, restore, set boundaries, and make aligned decisions—all of which will shape how I coach you. 

Birth Date (DD-MM-YYYY)

Birth Time (exact, if known – 24hr format preferred)
Birth Location (City, State/Province, Country)

Question 5 of 9

5) What are you currently struggling with most?

 

This could be burnout, people-pleasing, identity loss, lack of self-trust, boundaries, etc.

Question 6 of 9

6) What would feel like a breakthrough outcome for you over the next 3 months?

Question 7 of 9

7) Have you worked with a coach, healer, or mentor before? What was that experience like?

Question 8 of 9

8) Are you ready to invest time, energy, and financial resources into yourself at this level of support?

Question 9 of 9

9) Is there anything else you feel I should know about your journey, your desires, or your vision?