Mindfulness-Based Stress Reduction Course Application Form
Please answer the following questions to provide me with some information on what you hope to gain from this course and how I can best support you. This information is strictly confidential and will only be seen by me. We will also have the opportunity to speak one to one prior to commencing the course to discuss any further questions you may have regarding the program or your specific situation. You will also gain an awareness of what to expect from the course both as a general orientation and to provide further insight into the practice commitment necessary to gain the most benefit from this course.
You need to be aware that there is some home practice commitment of 45 to 60 minutes per day. This is to support you to bring mindfulness into all areas of your everyday life. The topic of home-based practice will be explored frequently throughout the course especially as a support to manage stress. The more you are able to put into your mindfulness practice the more you will gain from it.
Please note that MBSR is not psychotherapy or counselling. Nor does it aim to fix, cure or treat anyone. Instead, it will help you to relate to your experience in a new way and support you to access your own inner resources to bring about health and wellbeing to your own life.
Payment details will be provided on receipt of application form
If there are any aspects of the form you do not understand please do not hesitate to contact me.
Please complete all sections.
Please note MBSR has been proven to be effective in promoting health and wellbeing for individuals who are facing diverse challenges however this course may not be appropriate for you if you are experiencing the following:
1. Active substance dependence or in recovery for less than one year.
2. Suicidality, Psychosis, PTSD, severe Clinical Depression or other major psychiatric diagnosis.