Relational Dynamics Intake Form

™

Relational Dynamics

Intake Form

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Contact Information

First name

Last name

Phone

Choose your service type

Please select one option below

Individuals – Tier 1 (Foundational Blueprint)

Couples – Tier 1 (Union Dynamics Blueprint)

Birth Information

Please provide your birth details accurately for chart generation.

Your Birth Date

Month

Day

Year

Your Birth Time (exact if known)

Time

HoursMinutes

Your Birth City

Your Birth Country

Session Scheduling (for Practitioner Sessions Only)

Once your payment is confirmed, you will automatically receive a secure calendar link to schedule your session with our Blue Academy™ Practitioner at your preferred date and time.

Signature

Digital or Typed

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

Date

Month

Day

Year

Agreement & Confirmation

I confirm that all information provided is accurate to the best of my knowledge.

I understand that the insights and reports provided are for personal growth and energetic alignment purposes only.

I agree to Blue 5D™ Terms and Privacy Policy.