Business Coaching Request Form

DECODE. UNMASK. THRIVE.™ Blueprint

The Soul-Rooted Blueprint for Neurodivergent Liberation
A Little About You

Thank you and welcome to the DECODE. UNMASK. THRIVE.™ Blueprint.This section helps me gather the key details I need to generate your personalized charts and “soul maps.” Your responses will allow me to decode your energetic makeup through multiple modalities and deliver an in-depth breakdown that’s uniquely tailored to you.Take your time, answer as honestly as you can, and know this isn’t about perfection—it’s about precision and permission to be your full self.
Please fill out this form to the best of your ability. The more accurate and complete your responses, the deeper and more personalized your Blueprint analysis will be. This integrative approach combines soul contracts, astrology, Human Design, Ayurveda, blood type theory, and more to support your healing and expansion journey.

Required Information:
- Full Name at Birth (include name changes if applicable)
- Date of Birth
- Time of Birth (exact, if possible)
- Place of Birth
- Ayurvedic Dosha Type (if known)
- Blood Type
- Preferred Delivery Lens
- Neurdivergent Filter
- Email Address
Disclaimer Acknowledgement:
By submitting this form, you acknowledge that the DECODE. UNMASK. THRIVE.™ Blueprint is for educational and self-exploration purposes only. It is not intended to diagnose, treat, or replace professional medical or psychological care. Always consult your healthcare provider for any medical concerns.
Full Name at Birth*

First NameMiddle NameLast NameSuffix
Date of Birth (if time is Unknown use 12:00AM)*

MonthDayYear
DateHourMinutesAM/PM Option
Place of Birth*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Name Change(s): Please list any name changes you’ve had since birth—whether legal or adopted (e.g., through marriage, adoption, personal choice, etc.). Even if you did not legally change your name but commonly go by a different name (such as a spouse’s last name), this can impact the accuracy of certain charts. To ensure your Blueprint is as precise as possible, please include all names you've used. Example: Birth name: Jane Marie Smith → Adopted name: Jane Marie Johnson (married, uses spouse's last name) If this doesn't apply please just repeat your Name Information from above*

First NameMiddle NameLast NameSuffix
Age Name Change(s) started:*
Ayurvedic Dosha Type (if Unknown, take Dosha Quiz at: https://www.banyanbotanicals.com/pages/dosha-quiz, or click the 'Unknown' option.)

VataPittaKaphaVata-PittaVata-KaphaPitta-KaphaTri-Dosha'Unknown'
Blood Type (Try to be as accurate as possible, otherwise click 'Unknown')

AA+A-BB+B-ABAB+AB-OO+O-Unknown
Preferred Delivery Lens:

Therapeutically – Focused on emotional healing, inner child work, mental wellness, and practical shifts you can make to support nervous system regulation and personal growth.Somatically – Centered on the body’s wisdom, nervous system patterning, physical symptoms, and how energy/emotion is stored and processed physically.Somatically – Centered on the body’s wisdom, nervous system patterning, physical symptoms, and how energy/emotion is stored and processed physically.Therapeutically & Somatically – Combines emotional healing with body-based interpretations for a whole-person integration approach.Therapeutically & Soul Contractually – Blends psychological support with karmic insights to help you understand both the emotional and spiritual roots of your experiences.Somatically & Soul Contractually – Merges the body’s patterns with your soul’s mission, showing how your physical responses and symptoms are tied to deeper spiritual contracts.Therapeutically, Somatically & Soul Contractually – A holistic decoding of your blueprint through the mind, body, and soul for full-spectrum insight, transformation, and integration.
Neurodivergent Filter:

Create the Blueprint WITH the Neurodivergent Filter - This means your Soul Blueprint will be decoded through the lens of neurodivergence—highlighting how your wiring, behaviors, and sensitivities are divinely intentional. It includes layered interpretations of your soul contracts, design, and karmic lessons as they relate to neurodivergent traits.Create the Blueprint WITHOUT the Neurodivergent Filter - This version focuses on the foundational layout of your Soul Blueprint—your soul contracts, purpose, and design—without any interpretation tied specifically to neurodivergent expressions or traits.
Confirm E-mail (This is where your DECODE. UNMASK. THRIVE.™ Blueprint will be sent)*
Disclaimer:

The information contained within the DECODE. UNMASK. THRIVE.™ Blueprint and its related materials is intended for educational and self-exploratory purposes only. It is not a substitute for professional medical, psychological, or psychiatric advice, diagnosis, or treatment.

This Blueprint does not claim to diagnose, treat, or cure any physical, mental, or emotional condition or illness. Always seek the advice of your physician, licensed therapist, or other qualified health provider with any questions you may have regarding a medical condition, mental health concern, or treatment plan.

Participation in this program is voluntary and constitutes agreement to take full personal responsibility for your own wellbeing and decisions. The integrative insights provided are offered as complementary tools, not replacements for professional healthcare or therapy.

By signing below, you acknowledge that you have read, understood, and agree to the above disclaimer. You voluntarily accept full responsibility for how you use the information provided within this Blueprint and hereby release and hold harmless Christina Stevens and Phoenix Rebirth, including any affiliates, employees, contractors, or representatives, from any and all liability, claims, or damages that may arise from your participation or application of the material.

As well, by signing up, you’ll also get my newsletter with tips, tools, and offers. Unsubscribe anytime.
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⚠️ Please Note Before Purchasing:

If you purchase the DECODE. UNMASK. THRIVE.™ Blueprint after 1:00pm MST on September 28th, 2025, your order will be held until I return from a short break. Processing will resume on October 6th, 2025, and your Blueprint will be delivered no later than end of day October 7th, 2025 and continuing forward 24 hours from 'purchase'. For example, if you purchase 6pm September 28th, your blueprint will deliver by that time on the 8th, so forth and so on.

Thank you for your understanding and patience — your Soul’s Blueprint deserves my full energy and focus.

My Products

DECODE. UNMASK. THRIVE.™ Blueprint$150.00

An integrative, multidimensional soul map designed to help you uncover who you truly are beneath conditioning, trauma, and programming. This personalized blueprint includes multiple maps—from Human Design and Astrology to Soul Contracts and Ayurvedic energetics—woven together to reflect your unique coding, lived patterns, and healing approach. You’ll receive detailed access to all your decoded charts and descriptions through a private Notion link, delivered to your email within 24 hours of completed form submission.

Soul Map Activation (Design + Align)$900.00

3-Session Package to decode and ground the core of their energetic design. Perfect for those who are between “curious” and “all in.” What’s Included: Session 1 (90 min): Decode Their Core Map (HD, Astrology, Soul Contract, + Numerology overview) Focused on who they are, what energy they carry, and what they’re navigating now Session 2 (90 min): Soul Core Alignment Healing Same 120-min healing format, but done as part of a journey — allowing deeper insight to land and integrate Session 3 (90 min): Integration + Path Mapping Discuss patterns, voice reclamation, inner scripts, and next steps Could also be used as a practical support call (daily rhythm, boundary setting, somatic tools, etc.) Bonuses: Light chat/DM support in between Select access to Skool ND resources (limited compared to full 6-week) Option to apply this package toward the full 6-week container if they upgrade later

Soul Core Alignment Journey (Full Transformation)$1,400.00

6-Week Soul Core Alignment Journey ✅ What the Client Receives: Full Soul Blueprint (you hold the full version and reveal pieces week-by-week) 6 Live Sessions (90 min) Access to you via private messaging (e.g. Voxer, email, chat) Access to your ND Skool resources One full energy healing session in Week 4 Notion access to all client-specific materials, slowly revealed Ongoing reflection + integration tools

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DECODE. UNMASK. THRIVE.™ Blueprint

A Little About You