Mindbridge Application- Brian Can Help

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Email *

Name *

How did you hear about MindBridge (so we can thank them!)? *

Brian's social media

Brian's podcast

A friend or family member (tell me who in "other)

A current or past client (tell me who in "other")

An event, workshop, or speaking engagement (tell me which in "other")

Online search

Other:

Required

What made you interested in MindBridge? *

I want to understand myself better.

I keep reacting in ways I regret afterward.

I shut down or withdraw when I'm overwhelmed.

Conflict can escalate before I realize what's happening.

I have difficulty recognizing what I'm feeling until it's intense.

I struggle to communicate what I need.

I spend a lot of energy masking or trying to be who others need me to be.

I worry that my reactions will push people away.

I often feel misunderstood.

I want healthier relationships.

I want to stop being so hard on myself.

I understand a lot about myself intellectually, but struggle to use it in the moment.

Something else (explain below)

Other:

Required

When you're stressed, overwhelmed, or in conflict, what tends to happen? *

I get angry or reactive.

I become defensive.

I raise my voice or say things I regret.

I shut down.

I withdraw or need to get away.

I freeze and don't know what to say.

I agree or apologize just to end the conflict.

I have trouble explaining what I'm feeling.

I don't realize how overwhelmed I am until I've hit my limit.

I replay the interaction afterward.

I become very critical of myself afterward.

It varies depending on the situation.

I'm still trying to figure this out.

Other:

Where are these challenges affecting you most? *

My romantic relationship

Family relationships

Friendships

Parenting

Work

School

Social situations

My relationship with myself

Several areas of my life

Other:

Required

How much are these patterns affecting your life right now? *

A little — I mostly want to understand myself better.

Sometimes — they're creating challenges I'd like to address.

Quite a bit — they're affecting important parts of my life.

A lot — I feel like something needs to change.

I'm not really sure.

What would you most like help with? *

Recognizing overwhelm before I reach my limit

Understanding my emotions and reactions

Communicating what I need

Handling conflict differently

Recovering more effectively after difficult moments

Taking responsibility without beating myself up

Masking less and feeling safer being myself

Understanding my neurodivergence

Building healthier relationships

Developing more self-compassion

Setting and communicating boundaries

Understanding who I am underneath the masking

I'm not sure yet, I just know something needs to change.

Required

What tends to help you learn or make changes? *

Understanding why I respond the way I do

Having practical tools I can use in real situations

Talking things through with someone

Seeing examples I can relate to

Having time to process things on my own

Practicing something repeatedly

Having structure and accountability

Being able to ask questions

I'm still figuring that out.

Required

When someone challenges you or offers a different perspective, what usually helps? *

Direct, straightforward feedback

Gentle questions that help me reach my own conclusions

Examples that help me see the situation differently

Time to process before responding

A combination of these

I'm not sure.

Other:

Which best describes where you are right now? *

I'm curious and want to understand myself better.

I know something needs to change, but I'm not sure where to start.

I've already been working on myself and need better tools.

I'm ready to actively practice doing things differently.

Someone else encouraged me to apply, and I'm still deciding whether I want this.

Other:

How willing are you to look at your own behavior, not to blame yourself, but to understand what you can influence? *

I'm ready for that.

I'm willing, but I know it may be uncomfortable.

I'm not sure yet.

That's something I struggle with.

Required

If you decide MindBridge is the right fit, when would you ideally like to begin? *

As soon as possible

Within the next 30 days

Within the next 1–3 months

I'm interested, but I'm not ready to start yet.

MindBridge is a paid program. Which best describes where you are right now? *

I'm ready to invest in the right support if MindBridge feels like a good fit.

I'm interested and would like to understand the program and investment before deciding.

I would likely need a payment plan or flexible payment option.

I'm exploring my options right now and am not ready to make an investment.

In one or two sentences, what would you most like to be different after MindBridge? *

Is there anything else you'd like Brian to know as he reviews your application? *

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