Mindfulness MBSR Course Application Form - Mindfulness Courses Dublin

Please, fill out the form below to apply for the Mindfulness MBSR Course. These questions are to help explore your capacity to benefit from the course. Physical or psychological health difficulties are not necessarily a barrier to participation but need to be known to the Teacher to facilitate your best participation. Your replies will be completely confidential and if you have any questions or concerns about the questions just call me on 086 8206358.
Name *
Address
Date of Birth
Occupation
Phone
Email *
1. Do you have any experience of meditation/mindfulness practice? If so please say what that is.(no experience is necessary).
2. What are your reasons for attending this MBSR course and what benefits do you hope to get from it?
3. Do you have any physical difficulties with sitting, standing, walking or doing simple Yoga movements ?
4. Is there anything about your physical or psychological health that I should know of?
5. Are you taking any regular medication?
6. How did you hear about this MBSR Programme?
7. Any other relevant information?