Lightning Process Application Form Personal Details Name * First Name Last Name Email Address * Contact phone number * Address * Date of Birth * MM DD YYYY Gender * Please Select Male Female Other Occupation/Most recent occupation * PERSONAL HISTORY The reason that I ask about your past history is not because I have medical training but so that I can assist you in the best way possible How would you describe your illness/symptoms/issues? * Diagnosing Consultant/Doctor * Date of diagnosis * If applicable MM DD YYYY When did your symptoms/issues begin? * How did they start? How has this affected your life? * Do you know someone who has resolved their issues by doing the LP? Please select Yes No How did you hear about the Lightning Process? * * How did you hear about Neurospark? * Application Questions Have you read the LP book/listened to the audio download? * Please Select No Yes Are you willing to attend and participate in the discussions, training and coaching sessions? * Please Select Yes No Do you feel that you can influence your own health * Please Select Yes No Do you believe that you can get better/resolve your issues? * Please Select Yes No What do you hope to achieve from doing the course? * When you resolve your issues, what would you love to do with your life? * Have you applied to take the training before? * Please Select Yes No If 'yes' which practitioner did you apply to and when? What has changed for you since applying with that practitioner? I may need to speak to that practitioner about your application, please confirm that this is okay with you? Please Select Yes, I give my permission No, I don't give my permission Confidentiality Do you agree to maintain confidentiality with information shared by others during the training? * Yes, I agree Option Two If you are under 18 you will need your parent or guardian to read the Terms and Conditions for you. * I have read the terms and conditions. Name of parent/guardian If applicable These questions relate to the 'DATA PROTECTION POLICY' section of the terms and conditions. I would like to have my attendance certificate logged with The Lightning Process Head Office * This just ensures that it can be replaced if lost, helps with research/statistics and checks that a high standard of care is maintained by all practitioners. Please Selec Yes No I wish to receive occasional and relevant correspondence about developments from the Lightning Process London team. * Please Select Yes No I give permission to be contacted at regular intervals to monitor my progress for the purpose of further research into the Lightning Process. * Please Select Yes No Which Lightning Process dates were you interested in? Thank you!
