Human Design Intake Form

This form is for folks interested in a human design reading. Please fill out the form to the best of your ability allowing yourself to feel through the answers and have no judgement for questions left unanswered.

Sessions are $100 for a 75 minute session.

Name

First Name

Last Name

Date of Birth

MM

DD

YYYY

Time of Birth

If you don't have the exact time, leave this blank <3

Hour

Minute

Second

Birth Location (City, State)

Email

Current Timezone (For scheduling purposes!)

Have you ever had a Human Design reading?

Yes - I love HD!

No - I want to give HD a try :)

Is there anything in particular in your personal journey you are focused on at this time?

What would you like to gain from a HD reading?

Any questions for me? Anything additional you'd like me to know?

Confidentiality Agreement

I value your privacy and will honor that privacy by keeping our human design sessions confidential. The exception to that confidentiality would be if you expressed that you had (or intend to) hurt yourself or someone else, especially an elder, a child, or person who depends on you or others for care.

Click here to acknowledge and agree to Confidentiality Agreement

Human Design Intake Form

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