Coaching Intake Form

Name

First Name

Last Name

Email

What are your main goals and desires?

List your top 1-3 (business and personal)

What feels most challenging in your life right now?

What do you feel is working / not working?

Do you have any unhealthy habits, coping mechanisms, or addictions? If so, what are they?

What would you say your top values are?

List 3-5 that feel true for YOU (question whether these are YOUR values or whether they're inherited values). Feel free to use the values list below for inspiration.

What would you LOVE to feel in six months time?

List the emotions

What is your birth date, time, and place?

This is for me to understand more about who you are within Human Design so I can coach you in the most effective way, as well as help you realign with your strengths, intuition, and Self.

Is there anything else you'd love to share with me?

Share anything that is on your heart.