Mindfulness and Relaxation for Menopause waitlist

Your Registration Info

First Name *

Last Name *

Email Address *

Phone *

Street Address *

Supplemental Address 1

Supplemental Address 2

City

Postal Code *

Mindfulness for Stress

What do you hope to gain from this training? *

One of the aims of this course is to support you to establish a regular mindfulness practice. As such we ask all participants to start the course with a commitment to practising at home.

Are you happy to commit to practising mindfulness at home? *

Yes No

Do you have any physical illness or other limitation that may make hearing, sitting, standing, walking or doing simple exercises difficult for you? *

Yes No

Have you had any mental health issues or concerns within the last few years, such as anxiety or depression? *

Yes No

Have you experienced any traumatic events during the past year, such as close bereavement or relationship breakdown? *

Yes No

Further Details

How would you describe your current wellbeing? *

Do you have any special requirements, (e.g. needing large text) and are there any practical ways we can assist?

Any additional information

Where did you hear about this course? *

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Mindfulness and Relaxation for Menopause waitlist