Request edit access
Questionnaire for In Wave Group Mindful Training Programs
Please fill out the questionnaire and we'll get in touch with you. Or feel free to reach out to us at to set up your "Build Your Mindfulness Program Session".

The contents of this questionnaire, any supporting documentation, telephone conversations, email, and any other communication shall be considered confidential information.
Sign in to Google to save your progress. Learn more
Email *
Name *
Email *
Company Name & City, State (Location) *
How would you describe your company culture?
What are your company values?
Target Population
What is the target department/ group/ division? Describe the team function. Describe the team age range. Describe the team interaction and relationship.
Describe your company/team experience with mindfulness
Briefly describe your team's current challenges
How does this impact individuals? How does this impact the team? How does this Impact productivity?
What categories are you interested in integrating and focusing on?
Desired Outcomes
How would you describe your desired outcomes for an individual on your team? How would working optimally on your team look like?  
Describe any possible barriers/constraints to employees participation? (time or management support)
Previous Programs
 What has worked in the past? What was the success factor? What did not work? What was the cause?
Learning Modality
Will participants be receptive to instructional, experiential, reflection journaling components of program? Are you interested in individual coaching support?
Have employees participated in similar programs? How receptive will they be about participating? How ready is the company to commit to implementing this type of program?
How much time would employees have to participate? What part of the day would work best? Would 4-8 weekly sessions work best? When would be a good start date?
Are you interested in tailoring evaluations to your company's strategic goals and initiatives?  
A copy of your responses will be emailed to the address you provided.
Clear form
Never submit passwords through Google Forms.
This form was created inside of In Wave Group. Report Abuse