Rebel Curious Intake Form - Just Boldly Go

Hey! I’m so freaking excited to do this with you.

Please answer the following questions, and be sure to use your best email address, so I can send you your video Birth Chart & Human Design Type descriptions!!

Name
First Last
Email
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Website
Birth Date (Month, Day & Year)
Birth Time
: HH
MM
Birth Time
: HH
MM
Birth Location
In five sentences or less, tell me about your business.
Who is your ideal client?
What do you struggle with most in your business?
What are the top three things you need support with in regards to your business?
What's your relationship with money like?
In an average month, how much does $$ does your business generate?
How much would you like to be making per month?
Are the people closest to you supportive of your business and your goals?
If you could wave a magic wand and your life was exactly how you've always dreamed - what would it be like?