Intake form
As you complete this intake form, please do so as thoughtfully and thoroughly as possible. There are no "right" answers, only your unique truth. Once you submit this form, I will respond within 3 to 5 business days to let you know about possible next steps.

I applaud you for taking this powerful step & look forward to reading all of your responses. Thank you so much!
Email address *
First name *
Your answer
Last name *
Your answer
Your date and time of birth *
I need this information to calculate your Human Design chart. Important: 24h time format !!!
MM
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DD
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YYYY
Time
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Your place of birth *
I also need this to calculate your Human Design chart. Important: don't forget to add your country!
Your answer
What is your Human Design level of knowledge? *
Absolute beginner
Advanced
How long have you been in business? *
What's your business about? Who do you serve?
If you don't have a business, you can leave this blank.
Your answer
Do you have a website?
Enter your website url. If you don't have a website (yet), you can leave this blank.
Your answer
What are your social media handles?
Enter your social media ids/urls. If you don't have social media profiles, you can leave this blank.
Your answer
How did you find me and why are you interested in working with me specifically? *
Your answer
In what areas of your life/business are you looking for guidance/support? *
Are you experiencing any areas of struggle in your life/business at the moment? Tell me about it :-)
Your answer
What do you see as your 3 greatest gifts? *
These are the 3 things that you feel extremely confident about in supporting people through your work.
Your answer
What do you dislike about the way you see business being done? *
Your answer
How much money are you currently attracting? How much do you desire to earn? *
Your answer
What are your biggest dreams and goals for your business and life? If anything was possible, what would your dream business and life look and feel like? *
Please, describe your dreams/vision in detail.
Your answer
What do you believe are the top 3 things standing in your way from achieving those dreams? *
Your answer
Have you worked with a coach/mentor before? If so, what were you receiving support with, and how was that experience for you? *
Your answer
On a scale of 1 to 10, how confident are you in yourself and your workability to create impact and lasting transformation? *
Not confident at all
Extremely confident
On a scale of 1 to 10, how worthy and deserving do you feel of your dreams and goals? * *
Not worthy at all
Extremely deserving
Are you ready and willing to be an active participant in your transformation and show up fully for the work presented during our time together in this program? *
How do you see yourself within 5 years from now? *
Describe your vision in great detail.
Your answer
What do you hope to get out of this mentoring program? *
Remember, it is often so that we need multiple sessions to be able to meet your goals and needs.
Your answer
The total investment is €1111 (or 6x €195 in monthly installments). Is this level of investment something you are comfortable with and confident about being able to fulfill? *
What objections, hesitations, or concerns do you have about this program? Is there any way that I could help you with to feel more at ease? *
Your answer
Is there important health information I need to take into account? *
Anything you consider to be important to mention before we get started. You can count on my discretion.
Your answer
Anything you would like to add?
Whatever feels important to you to share with me.
Your answer
Thank you!
Know that filling in this form doesn't automatically result into us working together. I'm going to carefully read and examine your answers and take time to feel if we could be a match. You'll be notified of my answer within 3 to 5 business days. Thank you so much for understanding. If you feel like you need to add something, tell me something, have questions, or you don't want to go through with this journey, you can always drop me an e-mail at hello@daisydebcoaching.com.
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