Registration follow-on course | surreyhillsmindful

Registration form

6 week follow-on course

Send your details together with a deposit of £50 or full payment of £120

Name

Phone Number

Have you practised mindfulness before? Please describe any prior experience.

Why do you want to take this course?

What current stressors are you facing?

Are there experiences you've had in the past that are still causing you stress?

Is there anything relevant from your medical history, including your mental health, which you would like us to know?

Are you currently seeing a mental health professional, and if so, do they know that you are attending this mindfulness course?

Mindfulness practices include gentle stretching and movements. Please describe any physical health restrictions which you would like us to know about.

Are you taking any prescribed medication or do you self-medicate in any way?

Is there anything else you would like us to know?

Name and phone number of emergency contact

I accept terms & conditionsView terms and conditions

Select an item (£)

Deposit 6 week follow-on course - £50

Full fee 6 week follow-on course - £120

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