Self-Compassion and Mindfulness

ALL ARE WELCOME - PHYSICIANS AND HEALTH TEAM/OFFICE STAFF

We have received many requests from our physicians to include your Health Team/Office Staff in the Virtual Mindfulness Group: Simple Techniques for Complex Times, a virtual program. We welcome you to invite your Health Team/Office Staff to participate. Please complete the registration information for Team member(s) in the fields below. Once registered each Team Member will receive their own Confirmation.

Please Note: if more than 1 person is registering for the program, all registrations must be included on this form.  If you register a member of your office team please make sure to use their email address so that they receive a confirmation email. If you wish to register more than two Office Team members please contact Nicole at - 516-277-4326.
Please enter Physician registration information in the fields provided below.

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* 1. First Name:

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* 2. Last Name:

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* 3. Email: 

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* 4. Specialty

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* 5. Organization

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* 6. Designation:

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* 7. Who is your Medical Malpractice Insurance Carrier

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* 8. How did you learn about this program?  Please select all that apply

Please enter Heath Team/Office Staff registration information in the fields provided below.

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* 9. First Name

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* 10. Last Name

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* 11. Email

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* 12. Title

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* 13. First Name

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* 14. Last Name

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* 15. Email

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