Mindfulness-Based Stress Reduction Form

Mindfulness Based Stress Reduction Program

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This application begins your MBSR journey. Taking time to answer the questions is, in a way, your first mindfulness practice. First, be mindful of what drew you to this programme. It may be that you are curious, perhaps you have something on your mind or a life or health challenge. Perhaps you simply want to be more present and engaged. Take time to consider the following questions as best you can.

Part Two: Lifestyle/Medical Checklist:

1. What are your main stressors/challenges at present? *

2. Is there a particular challenge in your life at the moment and if so, how is this affecting you in daily life? *

3. Do you have any preexisting medical conditions or are you taking any medications you feel might be useful for me to know? *

4. Are you under the supervision of a mental healthcare professional at the moment? *

5. Have any major life events occurred over the past six months that might be useful for me to be aware of? *

6. Do you have anyone that is supporting you? Family, Friends, Counsellor? *

Part Three: Self-Reflection 7. Do you have any previous experience with Mindfulness & Meditation? *

8. What is your main reason for taking this programme? *

9. What brings you joy in your life? *

10. What are some of your strengths or qualities you like about yourself? *

11. Please provide any further information you feel might be helpful for me to be aware of. *

Freada McGoldrick, Mindfulness Based Stress Reduction Teacher, University of Massachusetts Medical Dept. Somatic Movement Educator. MythoSelf(r)Process Trainer with Applied Behavioural Technologies.

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Mindfulness Based Stress Reduction Program

Part Two: Lifestyle/Medical Checklist:

Freada McGoldrick, Mindfulness Based Stress Reduction Teacher, University of Massachusetts Medical Dept. Somatic Movement Educator. MythoSelf(r)Process Trainer with Applied Behavioural Technologies.

Please note all information is treated in strictest confidence.

Telephone

Hours

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Contact Freada McGoldrick

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Mindfulness Based Stress Reduction Program

Part Two: Lifestyle/Medical Checklist:

Freada McGoldrick, Mindfulness Based Stress Reduction Teacher, University of Massachusetts Medical Dept. Somatic Movement Educator. MythoSelf(r)Process Trainer with Applied Behavioural Technologies.

Please note all information is treated in strictest confidence.

Telephone

Hours

Find Us On:

We Would Love to Hear from you!Contact Freada McGoldrick

Email

Sign UP FOR OUR NEWSLETTER

We Would Love to Hear from you!
Contact Freada McGoldrick