Registration for the 5-week training in Mindfulness, March 2023
The following information is strictly for the confidential use of the course teacher, Susie Jones. Please answer these questions fully to enable her to guide you appropriately. 
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Name *
Email address *
How did you hear about this course? *
Have you attended this course with Susie before? *
Do you have any experience in mindfulness practices and meditation? If so, please give details.
Do you have any history of physical illness or any disabilities, which may significantly affect your sitting, standing, or walking practice?
Have you ever been diagnosed with or experienced any significant mental health issues, e.g. depression, eating disorders, anxiety, trauma, addictions, drug/alcohol abuse? If yes, please give details of condition(s) and date(s).
Describe any present circumstances that might place you under additional stress or may significantly affect your meditation practice (e.g. bereavement, redundancy, relationship breakdown, etc.)
Is there any additional information you would like to convey to the teacher?
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