Name*:
Address*:
Contact telephone number*:
Email Address*:
Sex:
Date of birth:
Occupation/Previous Occupation:
How did you hear about The Lightning Process?*
When would you like to attend the training?*

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A little information about your issues and future plans:

How would you describe your issues (include medical name and diagnosis if relevant):
Diagnosing Consultant/Doctor:
Date of Diagnosis:
When and how did your Issues/Symptoms begin?
How has this affected your life?
Do you believe you can resolve your issues/get better? yesno
Do you believe you can influence your own physical and mental health? yesno
Other Medical History:
What do you hope to achieve from doing the course?
What would you love to do with your life?
Have you applied to take the training before? yesno
Trainers name:
Would you like to be accompanied at the seminar? yesno

“I understand that the Lightning Process is a training programme. Its’ purpose is to train me in the tools of the Process, and I realise that simply attending will not guarantee me any results. I recognise the changes I want can best be obtained by fully participating and engaging in the seminars and continuing to apply it after. I am ready and committed to do this.” please select 'yes' in the box below:

Name*
Date*

I Agree* Yes

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