Mindfulness Pre Course Questionnaire

All the information provided will be held in strictest confidence only for your duration of participation in the course

Participants Name

First Name

Last Name

Have you any physical challenges that I need to be aware of? Difficulty with movement, hearing, mobility?

Have you any learning difficulties or diagnosis that I need to be aware of? How can I best support you with this?

Are you being or have you in the past been treated by a Psychologist or any other mental health professional? If so, for what?

Are there any particular subjects or topics you would like me to address during the course?

Is there any else you would like me to know about yourself before we begin?