Human Design Intake Form

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

AM PM

Have you ever had a Human Design reading?

Yes - I love HD!

No - I want to give HD a try :)

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