Free · Confidential · Approximately 8–12 Minutes

Discovery Intake Form

Please complete this Discovery Intake Form before your consultation, private session, personalized audio request or program recommendation.

Thank you for taking the time to share where you are now and what you are ready to change. This form supports grounded preparation, pattern awareness, responsible suitability review and more precise personalized guidance.

Short answers are fine. Honest answers are best.

Core route: Event → Subconscious Interpretation → Emotion → Behavior → Identity → Life

Anything you share will be treated with care, respect and confidentiality. This form is not emergency, medical, psychiatric or legal care. If urgent professional support is required, please contact an appropriate qualified service before completing the form.

Eduard personally reviews every Discovery Intake Form.

This form usually takes approximately 8–12 minutes. Your answers are reviewed privately and used to prepare for your consultation or requested pathway.

Your Details

Full Name *

Preferred Name (Optional - name you would like to be called)

Date of Birth *

Email Address *

Phone / WhatsApp *

Country / Location *

Time Zone *

Preferred Session Language *

Preferred Session Format *

How did you find Rewired Life Method™? *

Are you completing this form for a consultation, private session, personalized audio or program pathway? *

Current Situation & Root Patterns

Identity, Beliefs & Life Audit

These optional prompts help identify the beliefs, meanings and life areas connected to the pattern you are ready to change. Short answers are fine.

I often feel I am not… (Optional)

I learned that love means… (Optional)

I learned that success means… (Optional)

I learned that safety means… (Optional)

The belief I am most ready to release is… (Optional)

The belief I want to embody is… (Optional)

Rate each area from 1 to 10, where 1 means deeply unsatisfied or unsupported and 10 means highly satisfied and aligned. Add a note where useful.

Self-worth (Optional)

Relationships (Optional)

Career / purpose (Optional)

Money / receiving (Optional)

Body / health habits (Optional)

Emotional regulation (Optional)

Confidence / visibility (Optional)

Spiritual connection (Optional)

Daily structure (Optional)

Health, Safety & Suitability

Please answer honestly. These questions help keep any consultation, session or recommendation responsible, appropriately paced and aligned. A ‘yes’ answer does not automatically prevent participation.

1. Are you currently under medical, psychological or psychiatric care? *

2. Are you taking medication that may affect mood, sleep, focus or emotional regulation? *

3. Have you recently experienced a major crisis, hospitalization, traumatic event or significant instability? *

4. Are you currently at immediate risk of harming yourself or another person? *

5. Are you currently using alcohol, recreational drugs or other substances in a way that could affect session safety? *

6. Are you pregnant or currently managing a significant medical condition? *

7. Is there anything else Eduard should know to support you responsibly? (Optional)

Desired Change & Audio Personalization

These questions help clarify the change you want to create and, where relevant, the language and tone that may support a personalized audio experience.

Consent & Acknowledgement

Please review and confirm each statement before submitting your Discovery Intake Form.

I understand that my answers may include sensitive personal information. I explicitly consent to this information being processed solely to review my Discovery Intake Form, prepare for my consultation or requested service, and contact me regarding the appropriate next step, as explained in the Privacy Policy. *

I confirm that I have read and agree to the Privacy Policy. *

I understand that Rewired Life Method™ is not emergency, medical, psychological or psychiatric treatment and does not diagnose, treat or cure a medical or mental-health condition. The discovery process does not guarantee a particular result. *

Type your full name as acknowledgement *

Formal service agreements and any additional consent required for paid work may be completed separately before services begin.

Having trouble with the form? Email [email protected] and we'll help you directly.