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

Country CodePhone Number
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 in your life at the moment and what's bringing you here?
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 in your life? What do you feel is not aligned to who you 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.
Do you suffer or have you ever suffered from the following physical conditions?*
Please provide more details if you answered YES to any of the above, include when you were diagnosed, treatments you received and the duration.*
Please list any medications and food supplements you are currently taking
Do you smoke, consume alcohol or take recreational drugs ? Please provide details.
The live sessions run Saturday 10am 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