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Mindfulness Based Stress Reduction Program
Assessment of readiness to participate in the 8 week/9 session program
Contact details - address, email, phone, Skype
What is your reason (s) for wanting to participate in this program at this time?
What form(s) does stress take for you?
What practical ways do you use to manage stress?
Which of the following areas are you consistent in? Check all that apply
commitment to goals
Use of social media on a daily basis (1 is low and 5 is high)
What are the 2 main positive emotions that you experience regularly?
What are the 2 main negative emotions that you experience regularly?
Any physical illnesses and/or disabilities; emotional challenges; short or long term diagnosis?
Are you on medication?
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