Thank you for your interest in attending our course/workshop. Please fill out this questionnaire to get registered.


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* 1. Your contact info:

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* 2. Please tick any of the boxes that apply to you (Select all that apply.)

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* 3. Learner’s responsibility – Meditation is a safe and effective stress management tool.  However, if you have any of the following conditions or are under supervision by the mental health team/health care provider, we will require you to obtain consent from them to attend this meditation course.

 If you tick “yes” to any of the following contra-indications please either provide a letter from your mental health team/health care provider or alternatively sign the declaration below to confirm you have verbal consent from your mental health team/health care provider.

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* 4. By ticking the below box I declare I have made my mental health team/health care provider aware that I am attending a Meditation course or workshop and I agree that I will notify my mental health team/health care provider should my health or symptoms change during the course.

All the information on this form will be treated in the strictest confidence as per the Data Protection Act

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* 5. What is your key reason for wanting to learn meditation? e.g. Reduce stress and anxiety, learn to relax, improve sleep etc.

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* 6. What would you have liked to have happened as a result of completing a course or workshop with us? e.g. feeling calmer, understand the best type of meditation for me etc.

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* 7. On a scale of 1-10 (1 being no experience, 10 being an expert) where would you say you are in terms of being able to practice meditation?

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