Meditation Information and Consent Form

1.Full Name
2.Date of Birth
3.Phone Number
4.Email Address
5.Emergency Contact
6.Emergency Contact Phone and Email
7.Please describe your experience (if any) of Mindfulness and/or Meditation...
8.What are you hoping to get out of these sessions?
9.Please identify any current mental health concerns (including anxiety, depression, trauma, self harm) Please specify and detail any professional supports you are currently receiving.
10.I consent to attend and participate in a Mindfulness Meditation class with Anna Davies

I agree that I have informed Anna Davies of any physical, psychological or emotional issues which may be triggered by meditation

I agree to participate in activities at my own risk
Current Progress,
0 of 10 answered