human design
intake form

This form is for folks interested in a human design reading. Please fill out the form to the best of your ability allowing yourself to feel through the answers and have no judgement for questions left unanswered.

Name

First Name

Last Name

Date of Birth

YYYY

Time of Birth

Hour

Minute

Second

Birth Location (City, State)

Current Timezone (for scheduling purposes)

Will this be a Relationship reading (in connection with another person)?

Yes (Please fill in the fields below)

Your Email Address

Phone

(###)

###

####

Have you ever had a Human Design reading?

Yes

No - I want to give HD a try :)

Is there anything in particular in your personal journey you are focused on at this time?

What would you like to gain from a HD reading?

Any questions for me? Anything additional you'd like me to know?

human design
intake form

Thank you!

Laura will be sure to respond to you within 48 hours.

human design intake form

Thank you!

Laura will be sure to respond to you within 48 hours.

human design
intake form