Home
Coaching
Lightning Process
The Brain
Testimonials
About Libby
Contact
Shape
Created with Sketch.
Application for Lightning Process
PERSONAL DETAILS SECTION
{{errors.first('rs-89af-8a36-ca34', 'rs-89af-5f6c-a46c')}}
Name
{{errors.first('rs-89af-8a36-1f1c', 'rs-89af-5f6c-a46c')}}
Email
{{errors.first('rs-89af-8a36-fef3', 'rs-89af-5f6c-a46c')}}
Address / Post Code / Country
{{errors.first('rs-89af-8a36-5cf9', 'rs-89af-5f6c-a46c')}}
Phone Number
{{errors.first('rs-89af-8a36-02c3', 'rs-89af-5f6c-a46c')}}
Date of Birth
{{errors.first('rs-89af-8a36-08e7', 'rs-89af-5f6c-a46c')}}
Gender
Select
Female
Male
{{errors.first('rs-89af-8a36-5a80', 'rs-89af-5f6c-a46c')}}
Occupation/Most recent occupation
{{errors.first('rs-89af-8a36-4b55', 'rs-89af-5f6c-a46c')}}
PERSONAL HISTORY SECTION - To assist me to offer you the most professional level of support, please provide me with the following details
{{errors.first('rs-89af-8a36-d068', 'rs-89af-5f6c-a46c')}}
How would you describe your illness/symptoms/issues? (include medical name/diagnosis if relevant)
{{errors.first('rs-89af-8a36-b905', 'rs-89af-5f6c-a46c')}}
When did your symptoms/issues begin?
{{errors.first('rs-89af-8a36-0cbe', 'rs-89af-5f6c-a46c')}}
Date of diagnosis (if relevant)
{{errors.first('rs-89af-8a36-8674', 'rs-89af-5f6c-a46c')}}
Name(s) of consultant or doctor
{{errors.first('rs-89af-8a36-b83e', 'rs-89af-5f6c-a46c')}}
How did the symptoms/issues start?
{{errors.first('rs-89af-8a36-8f90', 'rs-89af-5f6c-a46c')}}
How has this affected your life?
{{errors.first('rs-89af-8a36-8e3b', 'rs-89af-5f6c-a46c')}}
APPLICATION QUESTIONS
{{errors.first('rs-89af-8a36-b481', 'rs-89af-5f6c-a46c')}}
Have you listened to the 'Part 1 of the Lightning Process' audio programme or read the Introduction book?
Select
Yes
No
{{errors.first('rs-89af-8a36-c495', 'rs-89af-5f6c-a46c')}}
Are you willing to attend and participate in the discussions, training and coaching sessions?
Select
Yes
No
Maybe
{{errors.first('rs-89af-8a36-b44f', 'rs-89af-5f6c-a46c')}}
Do you feel you can influence your own health?
Select
Yes
No
Maybe
{{errors.first('rs-89af-8a36-f07c', 'rs-89af-5f6c-a46c')}}
Do you believe you can get better/resolve your issues?
Select
Yes
No
Maybe
{{errors.first('rs-89af-8a36-9dc0', 'rs-89af-5f6c-a46c')}}
What do you hope to achieve from doing the course?
{{errors.first('rs-89af-8a36-013f', 'rs-89af-5f6c-a46c')}}
When you resolve your issues, what would you love to do with your life?
{{errors.first('rs-89af-8a36-cff4', 'rs-89af-5f6c-a46c')}}
Have you applied to take the Lightning Process training before?
Select
Yes
No
{{errors.first('rs-89af-8a36-ae09', 'rs-89af-5f6c-a46c')}}
If yes, which practitioner did you apply to and when?
{{errors.first('rs-89af-8a36-d1f6', 'rs-89af-5f6c-a46c')}}
What has changed for you since applying with that practitioner?
{{errors.first('rs-89af-8a36-043f', 'rs-89af-5f6c-a46c')}}
Should I need to speak to that practitioner about your application, please confirm that this is okay with you.
Select
Yes, I give my permission
No, I don't give my permission
{{errors.first('rs-89af-8a36-f2b7', 'rs-89af-5f6c-a46c')}}
Do you know of someone who has resolved their issues by doing the Lightning Process?
{{errors.first('rs-89af-8a36-0fc1', 'rs-89af-5f6c-a46c')}}
How did you hear about the Lightning Process?
{{errors.first('rs-89af-8a36-5a21', 'rs-89af-5f6c-a46c')}}
How did you hear about Libby Gairdner and The Shift?
{{errors.first('rs-89af-8a36-4766', 'rs-89af-5f6c-a46c')}}
AGREEMENT - NB If you are under 18 your parent or guardian will need to read and accept the Terms and Conditions on your behalf.
{{errors.first('rs-89af-8a36-b4c5', 'rs-89af-5f6c-a46c')}}
I have read and accepted the Terms and Conditions
{{errors.first('rs-89af-8a36-e353', 'rs-89af-5f6c-a46c')}}
Parent/Guardian (if applicable)
{{errors.first('rs-89af-8a36-af6f', 'rs-89af-5f6c-a46c')}}
THE FOLLOWING QUESTIONS RELATE TO THE DATA PROTECTION POLICY SECTION OF THE TERMS AND CONDITIONS
{{errors.first('rs-89af-8a36-dddf', 'rs-89af-5f6c-a46c')}}
I would like to have my attendance certificate logged with the Lightning Process Head Office
Select
Yes
No
{{errors.first('rs-89af-8a36-7160', 'rs-89af-5f6c-a46c')}}
I wish to receive occasional and relevant correspondence about developments in the Lightning Process
Select
Yes
No
{{errors.first('rs-89af-8a36-7f43', 'rs-89af-5f6c-a46c')}}
I give my permission to be contacted at regular intervals to monitor my progress for the purpose of further research into the Lightning Process
Select
Yes
No
{{errors.first('rs-89af-8a36-8434', 'rs-89af-5f6c-a46c')}}
Address
Submit
Your application has been submitted. Libby will contact you soon.
Make the shift today
Contact Libby
Shape
Created with Sketch.
Home
Coaching
Lightning Process
The Brain
Testimonials
About Libby
Contact
Blog