Mindfulness Questionnaire
Please use this form to provide feed back on your need and interest for a Mindfulness course in your local area.

Scientific research supports the effectiveness of mindfulness for reducing depressive relapses, reducing cravings for substances people are addicted to, combating stress and being an effective tool for managing chronic pain and health conditions.

A Mindfulness programme takes place over 8 weeks. There is weekly course content and practice is done outside of the sessions with the use of MP3 audio to integrate mindfulness into daily routines and help positively change old habits and behaviours.

More information can be found at www.timelliston.co.uk & www.thehappystarfish.com. Please check out these web sites, they are full of useful information and inspiration.

A little bit of information about you.
The following questions allow us to contact you and follow up with you when we have Mindfulness groups or events running in your area.
First name *
Your answer
Last name *
Your answer
Phone number
Your answer
Email address *
Your answer
The town or village you living in (Just so we can schedule convenient venues) *
Your answer
More about your thoughts and possible need for Mindfulness.
These answers help us to know what your needs might be and allow us to provide courses and services that can really help you. Your answers and any information that you provide is confidential and kept private and all times.
Do you feel you suffer sometime or all the time from ...? (Tick all that apply) *
How aware are you of mindfulness, Mindfulness Base Cognative Therapy (MBCT) or Mindfulness Base Stress Reduction (MBSR)? *
Would you like learn about Mindfulness to benefit your life and general well being? *
If you would like to learn about Mindfulness, when works best for you? *
Thank you.
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