Rewire and Rise Application Form

Before we speak

Thank you for reading that far, and for getting this far.There are 10 or so questions here and it takes about 10 minutes. Some of them are open, and I'd rather have a real sentence than a tidy one — write however much you want to. Nobody sees these but me. Once you've sent it, you'll be able to book a half hour with me straight away.
Full Name

First NameLast Name
Email Address
example@example.com
A number I can reach you on - WhatsApp is easiest, if you use it
Please enter a valid phone number.Format: (000) 000-0000.
Where in the world are you?
City and country is plenty — I just need to know what time zone we're working across.

What's going on for you at the moment — and what made you read that page today?
However much or however little you want to say. There isn't a right answer to this one.
Where do you feel you're holding yourself back, or making yourself smaller than you actually are?
At work, at home, with people, on your own — wherever it shows up most.
Have you tried to work on this before? And what happened?
Therapy, books, a course, a reading, or just quietly by yourself. It all counts, including the things that didn't go anywhere.
If we did these twelve weeks and it really worked — what would be different by [BY WHEN]?
Be as specific as you can. "Happier" is honest, but "I'd have actually said the thing" tells me far more.
There's a short health and medication check we go through before anyone starts, and I'd rather do that properly on the call than in a box on a form. For now, just so I know what to prepare — is there anything to do with your health, your medication, or your mental health that we should take into account?

Other

The live sessions run Tuesdays 7pm London time, every week for twelve weeks. Can you make most of them?
Anything else you'd want me to know before we talk?
I'm happy for Noel to hold what I've written here so we can have a proper conversation about it. [Privacy policy]
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Before we speak