Application Form for MBSR

You may be asked the following questions in your orientation session so you may like to begin to reflect on them:

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Name *

First

Last *

Last

Email *

Phone *

Emergency Contact *

How did you hear about the course?

Do you have any experience with meditation? *

Do you have time in your life at the moment to do the home practice of about 45mins each day, which is central to the course? *

What are your expectations of the course? *

Are you suffering from any emotional or physical condition that you think might be relevant? *

Have you any experience of counselling or therapy? Completing a MBSR course can be challenging. Sometimes when we stop and pay attention to our own experience issues can arise which we may need some help with. Would you be willing to seek professional help if the need arises? *

If you are in therapy, have you consulted with your therapist about your intention to participate in the course? *

If you are human, leave this field blank.

This information will not be shared with anyone other than your teacher and their supervisor. At the end of the course any personal information will be destroyed.

Recommended donation of €100 for the course fees and materials

Click here to donate

Application Form MBSR