SIT Registration April 2020
The following information is strictly for the confidential use of the course teacher, Susie Jones. Please answer these questions fully to enable her to guide you appropriately. Disclosure of any physical/psychological history will not necessarily prevent you from undertaking a mindfulness course.
Name (first name + surname)
How did you hear about this course?
Directly from Susie in person or via email
Another teacher, therapist or centre
Do you have any history of physical illness or any disabilities, which may significantly affect your sitting, standing, or walking practice?
Have you ever been diagnosed with or experienced any significant mental health issues, e.g. depression, eating disorders, anxiety, trauma, drug/alcohol abuse? If yes, please give details of condition(s) and date(s).
Describe any present circumstances that might place you under additional stress or may significantly affect your meditation practice (e.g. bereavement, redundancy, relationship breakdown, etc.)
Is there any additional information you would like to convey to the teacher?
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