Mindfulness Group Coaching Client Application Form
Hey Lovely! Thanks you so much for your interest in applying for my Mindfulness Group Coaching 
to start your inward mindfulness journey.  

My Unique Mindfulness Coaching Approach
  • Talk / Meditation Therapy
  • Top Down Coaching Approach
  • 3 Step Formula To Win Your Mind
  • Research / Science Based Comprehensive Exercises
  • Guided Breathworks / Meditations
  • Complimentary Health Treatment
  • Embodied Mindfulness Practices
  • Kind and Non Judgmental Space
  • Fun and creative Mindfulness Activities
  • GROW Coaching Model

To Your Mindfulness & Happiness,
Vasantha Vivek
Certified Mindfulness Coach

If you are really curios to start your inward mindfulness journey immediately, then kindly fill up this form, I'll review all the information and I will get back to you on email with the next steps within one week.

I'm very much excited to help you in your journey. All the very best for your application process. If you have any doubts, please feel free to reach out to me on : coachingbyvasantha@gmail.com

P. S: Please note that you will be added to the mail list of my free monthly mindfulness newsletter - LEELA. You can unsubscribe anytime.

First thing first, what made you to apply for this coaching session? *
Name *
Age & Gender *
City & Country *
Instagram Name (Answer NA if you are not having an Instagram account) *
Instagram URL (Answer NA if you are not an Instagrammer) *
Any other social media handles such as YouTube/podcast/twitter (if any) *
How do you know me? *
What role(s) do you love the most? *
I know ____________ about mindfulness *
Who are you as a Mindfulness Practitioner? *
Briefly define your mindfulness/life goals for next one month/year *
At present, what is your biggest roadblock in your life *
What could be the right solution for your current situation? *
Have you ever attended a mindfulness course/workshop/webinar/One On One/ Group Coaching? *
Any other information to share ( More details, more better ) *
This is a highly an action taking and deep inner work program. You will be needing to implement all the suggestions and instructions step by step (Don't worry, I will be guiding you through). Are you ready to take your inward mindfulness journey sincerely? *
There would be 4 one and half hour mindfulness coaching sessions that you would be needing to attend. And also can you invest 10 to 20 minutes for yourself each day for one to two months to start your inward mindfulness journey sincerely? *
Is there any specific limiting belief or mindset issue blocking your progress? If yes, mention it here. *
Which Mindfulness Group Coaching would you like to apply for? *
Describe your requirements based on what you opted above. Be as descriptive as possible for me to come prepared and having some background, so we can directly deep dive into strategy. *
I understand that these personalized sessions involve money for my effort and time. Have you made the necessary financial assessment and are you in a position to invest? *
Will you be willing to provide an honest detailed feedback about your learnings and experience from my mindfulness intensive program.? *
A copy of your responses will be emailed to the address you provided.
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