Consultation Request

“WE KEEP FACING THE SAME ISSUES
AND CHALLENGES IF WE DON’T IDENTIFY
WHY THE PATTERN KEEPS HAPPENING.”

Due to a busy schedule, availability is very limited. Someone will contact you when an appointment become available.

 

Derek O’Neill
Consultation Request Form

 

Your Name (required)

Your Email (required)

Your telephone number (please include country and area code) (required)

How would you prefer us to contact you?
By emailBy phone

Are you interested in a Private or Group Consultation?
PrivateGroup

Where are you based? (required)

Occupation

Presented issue (required)

Short medical history if associated with your presenting issue (required)

Other people you worked with on issue

What would be your ideal outcome from this work together? (required)

How did you hear about Derek's work? (required)

Have you attended any of Derek's workshops?
YesNo

Any other information you wish to include

 

SQ WORLDWIDE

244 5th Avenue
Suite D-264
New York, NY 10001

Visit FAQ for support questions.


CONNECT WITH DEREK