The version of the browser you are using is no longer supported. Please upgrade to a supported browser.Dismiss

Send
Section 1 of 2
Mindfulness-Based Cognitive Therapy for Life (MBCT-L)
  1. We are now offering the 8-week MBCT-L course - to flourish your well-being and relationship. 
Before the course orientation, the instructor has to aware of the participants' health situations to maintain the safety of delivering the course, and practice the ethical guidelines to deliver the course.  
We will ensure to maintain data confidentiality.
課程介紹 - 教師需了解參加者健康狀況而保證課堂安全的進行與遵守OMC靜觀老師的道德操守。
我們確保資料絕對保密。
Email
This form is collecting emails.Change settings
Loading image…
Loading...
Loading…
Name
Question Type
Loading image…
Answer key
(0 points)
Loading...
Loading…
DOB
Question Type
Loading image…
Answer key
(0 points)
Loading...
Loading…
Section 2 of 2
Oxford Mindfulness Centre - MBCT- L
i9Before the course orientation, the instructor has to aware of the participants' health situations to maintain the safety of delivering the course, and practice the ethical guidelines to deliver the course.  
We will ensure to maintain data confidentiality.
課程介紹 - 教師需了解參加者健康狀況而保證課堂安全的進行與遵守OMC靜觀老師的道德操守。
我們確保資料絕對保密。
1. Any long-term illness, physically or mentally?
Question Type
Loading image…
Yes 是
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
Loading…
2. Have you experienced depression in the past 6 months? 在過去的 6 個月內，您是否經歷過抑鬱症
Question Type
Loading image…
Yes 是
No 否
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
Loading…
Please specify if yes from the previous question. 在上題答案是的， 請説明。
Question Type
Loading image…
Answer key
(0 points)
Loading...
Loading…
3. Are you currently experiencing depression? 您目前是否患有抑鬱症
Question Type
Loading image…
Yes 是
no
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
Loading…
Please specify if yes from the previous question. 在上題答案是的， 請説明。
Question Type
Loading image…
Answer key
(0 points)
Loading...
Loading…
5. Have you experienced a psychotic episode in the past? 您過去是否精神病發作過的經歷
Question Type
Loading image…
Yes 是
No 否
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
Loading…
Please specify if yes from the previous question. 在上題答案是的， 請説明。
Question Type
Loading image…
Answer key
(0 points)
Loading...
Loading…
6. Are you currently receiving any psychiatric or psychological treatments? 您目前是否正在接受任何精神病或心理治療
Question Type
Loading image…
Yes 是
No 否
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
Loading…
Please specify if yes from the previous question. 在上題答案是的， 請説明。
Question Type
Loading image…
Answer key
(0 points)
Loading...
Loading…
7. Are you currently taking any medication? 您目前是否正在服用任何藥物
Question Type
Loading image…
Yes 是
No 否
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
Loading…
Please specify if yes from the previous question. 在上題答案是的， 請説明。
Question Type
Loading image…
Answer key
(0 points)
Loading...
Loading…
8. Are you taking any talking therapy? 你在接受談話療法嗎
Question Type
Loading image…
Yes 是
No 否
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
Loading…
Please specify if yes from the previous question. 在上題答案是的， 請説明。
Question Type
Loading image…
Answer key
(0 points)
Loading...
Loading…
9. Have you deliberately harmed yourself in the past year ? 在過去的一年裡你有沒有故意傷害自己？
Question Type
Loading image…
Yes 是
No 否
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
Loading…
Please specify if yes from the previous question. 在上題答案是的， 請説明。
Question Type
Loading image…
Answer key
(0 points)
Loading...
Loading…
10.Have you ever attempted to take your own life? 你有沒有嘗試過結束自己的生命
Question Type
Loading image…
Yes 是
No 否
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
Loading…
11. Have you ever experienced a severely traumatic event which if affecting you? 你有沒有經歷過嚴重的創傷事件影響到你？
Question Type
Loading image…
Yes 是
No 否
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
Loading…
Please specify if yes from the previous question. 在上題答案是的， 請説明。
Question Type
Loading image…
Answer key
(0 points)
Loading...
Loading…
12. Have you experienced bereavement in the past year? 在過去的一年裡，你經歷過喪親之痛嗎
Question Type
Loading image…
Yes 是
No 否
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
Loading…
13. Are you currently under alcohol/drug in order to manage your stress/ distress? 您目前是否正在酗酒/吸毒以緩解壓力/困擾
Question Type
Loading image…
Yes 是
No 否
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
Loading…
14. Are there any current life changes ( loss of home, job, relationship, breakdown, too many work commitments etc. ) that may be placing you under additional stress? 目前的生活是否有任何變化（失去家庭、工作、關係、崩潰、太多的工作承諾等）可能會給您帶來額外的壓力
Question Type
Loading image…
Yes 是
No 否
Add option
or
add "Other"
…
Answer key
(0 points)
Loading...
Loading…
Please specify if yes from the previous question. 在上題答案是的， 請説明。
Question Type
Loading image…
Answer key
(0 points)
Loading...
Loading…
15. What do you hope to gain by attending the course? 您希望通過參加課程獲得什麼
Question Type
Loading image…
Answer key
(0 points)
Loading...
Loading…
Anything I wish to let my instructor aware of?  有什麼我想讓導師知道的嗎？
Question Type
Loading image…
Answer key
(0 points)
Loading...
Loading…
Link to Sheets
Message for respondents
This form is no longer accepting responses
Insights
Total points distribution
Loading...
Loading responses…
Name
Copy
No responses yet for this question.
DOB
No responses yet for this question.
Oxford Mindfulness Centre - MBCT- L
1. Any long-term illness, physically or mentally?
Copy
No responses yet for this question.
2. Have you experienced depression in the past 6 months? 在過去的 6 個月內，您是否經歷過抑鬱症
Copy
No responses yet for this question.
Please specify if yes from the previous question. 在上題答案是的， 請説明。
No responses yet for this question.
3. Are you currently experiencing depression? 您目前是否患有抑鬱症
Copy
No responses yet for this question.
Please specify if yes from the previous question. 在上題答案是的， 請説明。
No responses yet for this question.
5. Have you experienced a psychotic episode in the past? 您過去是否精神病發作過的經歷
Copy
No responses yet for this question.
Please specify if yes from the previous question. 在上題答案是的， 請説明。
No responses yet for this question.
6. Are you currently receiving any psychiatric or psychological treatments? 您目前是否正在接受任何精神病或心理治療
Copy
No responses yet for this question.
Please specify if yes from the previous question. 在上題答案是的， 請説明。
No responses yet for this question.
7. Are you currently taking any medication? 您目前是否正在服用任何藥物
Copy
No responses yet for this question.
Please specify if yes from the previous question. 在上題答案是的， 請説明。
No responses yet for this question.
8. Are you taking any talking therapy? 你在接受談話療法嗎
Copy
No responses yet for this question.
Please specify if yes from the previous question. 在上題答案是的， 請説明。
No responses yet for this question.
9. Have you deliberately harmed yourself in the past year ? 在過去的一年裡你有沒有故意傷害自己？
Copy
No responses yet for this question.
Please specify if yes from the previous question. 在上題答案是的， 請説明。
No responses yet for this question.
10.Have you ever attempted to take your own life? 你有沒有嘗試過結束自己的生命
Copy
No responses yet for this question.
11. Have you ever experienced a severely traumatic event which if affecting you? 你有沒有經歷過嚴重的創傷事件影響到你？
Copy
No responses yet for this question.
Please specify if yes from the previous question. 在上題答案是的， 請説明。
No responses yet for this question.
12. Have you experienced bereavement in the past year? 在過去的一年裡，你經歷過喪親之痛嗎
Copy
No responses yet for this question.
13. Are you currently under alcohol/drug in order to manage your stress/ distress? 您目前是否正在酗酒/吸毒以緩解壓力/困擾
Copy
No responses yet for this question.
14. Are there any current life changes ( loss of home, job, relationship, breakdown, too many work commitments etc. ) that may be placing you under additional stress? 目前的生活是否有任何變化（失去家庭、工作、關係、崩潰、太多的工作承諾等）可能會給您帶來額外的壓力
Copy
No responses yet for this question.
Please specify if yes from the previous question. 在上題答案是的， 請説明。
No responses yet for this question.
15. What do you hope to gain by attending the course? 您希望通過參加課程獲得什麼
No responses yet for this question.
Anything I wish to let my instructor aware of?  有什麼我想讓導師知道的嗎？
No responses yet for this question.
Settings
Responses
Manage how responses are collected and protected
Presentation
Manage how the form and responses are presented
Defaults
Form defaults
Settings applied to this form and new forms
Question defaults
Settings applied to all new questions
.