THERAPY BY DESIGN

The Beginning Of Your New Life

Please answer these questions so I can learn more about you before the call

First Name *

Last Name *

Email *

Phone *

Date, time, and location of birth as accurately as possible (so I can pull your Human Design Chart)? *

What are your most important goals? *

What is your biggest mental block? *

What is your next annual business goal? *

I’m just starting my business

$100,000

$500,000

$1,000,000

$10,000,000

$100,000,000

How do you rate your relationship with your partner? *

Amazing

Good

Average

Bad

How do you rate your relationship with your children? *

I don't have children

Incredible

Good

Average

Bad

How do you rate your self-care? *

Amazing

Good

Average

Bad

You are close to having a specific map to achieve your goals and break through the blocks that keep you stuck. Are you committed to giving it your all and taking action? *

Yes

No

By providing my email address and phone number, I agree to receive text messages from the business.

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