Mindfulness for Living, for Learning, for Working, for Life

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This website will hopefully go a little way to answer some of the questions you may have about Mindfulness, how it can be used and who may benefit from the practice of Mindfulness.

Many more questions may arise and if so why not ask us?

Course Registration Form

Mindfulness for Living Well

We would appreciate you filling in this form and providing us with some personal details. Any information you provide will be treated confidentially. Your details will be stored securely and will not be passed onto a third party.


Name:

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Date of Birth:
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Phone:

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Mobile:

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Email address:

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How did you hear of the Mindfulness course?

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Medical History
Answering the following questions will help us to understand your reasons for participating in the course and what you hope to gain from it.


What are your main reasons for enrolling on the Course?

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Which areas of your lifestyle or behaviours would you like to change?

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Do you have any difficulties sleeping?

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How much exercise do you take each week? Please give details.

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How would you describe your diet and eating habits?

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Do you have any physical or psychological symptoms? Are they particularly severe at this time?

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Have you any medical diagnoses? Please give details.

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Are you taking any prescribed medication? Please give details.

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Are you receiving any other medical treatments? E.g. Physiotherapy, Counselling.

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Are you receiving any complementary health therapies? E.g. Aromatherapy, Massage.

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Please tell us about any current stressors in your life. EG: Bereavement, Divorce.

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Do you have any previous meditation experience? If so, how often do you meditate? And how many years/months have you been meditating for?

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Are you comfortable talking in a group?

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Are you able to sit in silence for up to 30 minutes?

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