TID Private Community Intake Form

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Name* This field is required.
First Name
Last Name
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Email* This field is required.
example@example.com
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Whats App Phone Number
Area Code
Phone Number
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Your date and time of Birth, city and country for Astrology & Human Design* This field is required.
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Have you been referred to Dheeraj by someone? If so, who?
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What country do you live in?
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How did you hear about my coaching programs?
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Why do you want to specifically work with me?
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What is your primary goal or intention for seeking coaching at this time?
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Have you worked with a mentor before?
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Why do you believe now is the right time for you to embark on this coaching journey? What has changed or prompted this decision?
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What will happen if you don't take this step?* This field is required.
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In as much detail as possible, what is currently happening in your life right now?
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Do you have a good relationship with your mother?
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Do you have a good relationship with your father?
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Rate your relationships in your life 1/10 1 being not good 10 being incredible
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Rate your communication skills 1/101 being not good 10 being incredible
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How well are you able to take direct feedback 1/101 being not good i'm hyper critical of myself 10 being incredible I don't take it personally and I implement it well
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How do you currently feel about your ability to manifest your desires? What specific challenges are you facing in this area?
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On a scale of 1 to 10, how emotionally empowered do you feel to make significant changes in your life? Please explain your rating.
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What are your top three emotional challenges or barriers that you believe are preventing you from achieving your goals?
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What areas of your life do you currently need support in?
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Do you have a partner you need to run financial decisions by?
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28. Your current income level:>50,000 80,000-120,000 120-200,000 200,000 +
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How much are you willing to invest in your personal growth and transformation on call?>5000 <5000 <10,000
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How much would you be willing to invest in yourself per month?>5000
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Would you be willing to invest in yourself on call to secure our partnership?
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How dedicated and committed are you to investing in yourself?1/10 1 being least 10 being most
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When are you looking to get started?Now i'm ready! under 30 days or over a month
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How do you typically handle setbacks or obstacles in your life?
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What specific areas do you need the most help with (e.g., managing thoughts, setting intentions, taking action, maintaining momentum)?
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Have you tried breathwork, yoga, or meditation previously? If so, please describe your experience and which practices you have tried.
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Do you currently use any mental, physical, or emotional techniques? If so, please describe them.
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What are your social media handles? (e.g., Instagram, Facebook, LinkedIn, TikTok, Twitter)
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Are you currently practicing any techniques related to emotional intelligence or energy work? If so, please describe them.
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What are your top 5 values?
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How often do you push yourself beyond your limits or comfort zone?
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How much time can you realistically dedicate to your coaching sessions and related practices each week?
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On a scale of 0 to 10, how important is it for you to make a change right now? and do you feel empowered to make a change?
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Do you know your purpose? If so, please share it here.
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Fast forward to 5 years from now. Describe how your life is in as much detail as possible.
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What are you currently doing to NOT achieve your 5-year vision?
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Is there anything else you'd like to share?* This field is required.
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I understand that completing this form thoroughly and truthfully will allow Dheeraj to understand you holistically. On call I may offer other solutions or programs to suit your needs and financials.
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I have downloaded zoom in preparation for a call
YESNO
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