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 becomes 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.