[Imported] Human Design Intake Form

Seidrkin Intake Form

Thank you for reaching out to work with me. This form will help me get a better idea of what you ned and how I can support you wherever you are in your life right now. The more detail, the better. Looking forward to talking with you. Emma
Email
example@example.com
What is your full name?*
What's your birth date? Note: To avoid confusion with U.S. vs European format, please write the month instead of using its number (e.g. Apr 10, 2025)*
What's your exact birth time? Note: If your birth time is an estimate, or if you simply don't know it, please note that in your response.*
What city/state/country were you born in?*
Where in your life do you feel like you're excelling at the moment?*
Where in your life do you feel like you're struggling at the moment?*
What inspired you to seek support at this time in your life?*
What inspired you to seek support from me specifically?*
What's your desired outcome from working with me?*
What do you love about yourself?*
What do you have a hard time accepting about yourself?*
What's your experience with the Human Design system? Note: It's a-ok if you barely know what it is, or if you've done quite a bit of digging. I want to make sure I'm meeting you where you're at right now.*
Which of these resonates most with you?*

I want to better understand why I am the way I am.I want to feel seen and understood. I want permission to be myself.I want practical, actionable things to help me navigate where I'm at in my life right now.I want all the above.I don't really know. I'm open to any and all insights.
What form of support are you most drawn to?*

I need 1:1 ongoing support for longer than 3 monthsI need 1:1 ongoing support for longer one monthI need one session to get clarity on a clearly defined struggleI need message support for at least a month to help me integrate what I've learnt and reflect back where I need to adjust my process.I want all the above.I really want to be part of a group to learn and grow and integrate changes along with the support and inspiration of others also on this journey.
Is there anything else you'd like me to know?
Should be Empty:

Seidrkin Intake Form