Fundamentals of Mindfulness Participant Questionnaire

Name:

Email Address:

Phone Number:

Address:

Occupation

Age:

How did you find us?

What current challenges have brought you to the Fundamentals of Mindfulness course?

What has helped?

What is the quality of your sleep?

What challenges might come up in finding time for the home practice each day?

Have you experienced things in your life that were overwhelming, either earlier on in life, or more recently?

Can you let me know any medications you are currently taking for physical/mental health reasons?

Are you currently seeing a counsellor or therapist?

What strengths do you bring into learning something new like this?

Introduction to Mindfulness Questionnaire