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Your Commitment
Congratulations! You are taking the first step to setting yourself up for success as you commit to practicing mindfulness.
This survey is to help you with the 4Cs:
1) Consistent Practice: making a plan
2) Commitment: declaring your decision
3) Compassion: proceeding with kindness
4) Community: being witnessed in your efforts and benefiting from accountability
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#1: CONSISTENT Practice
Let's Make a Plan! The following questions are intended to help you get clear on the form your practice will take.
What will you practice (type of practice, length, frequency)? For example, "Body Scan, 5 mins, daily".
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Your answer
When will you practice? (time of day or situation)
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Your answer
How will you practice? (e.g. where will you be? will you use an app or timer?)
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Your answer
#2: COMMITMENT
Connect with your decision and your driving force.
On a scale of 1 to 10, how ready are you to commit to your chosen practice?
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Not at all
1
2
3
4
5
6
7
8
9
10
Very
Why are you making this commitment?
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Your answer
#3: COMPASSION
Proceed with kindness
What do you believe your greatest challenge will be in sticking with your plan? How can you best support yourself through this?
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Your answer
How will you choose kindness when you miss one (or many) practice times?
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Your answer
#4: COMMUNITY
Here you are invited to be witnessed in your efforts and benefit from accountability. Simply by completing this form, you have shared your commitment with Miriam at Brain Spa!
Is there someone else you'd like to share your commitment with (a friend, a colleague, or a group via social media)?
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Your answer
Would you like to participate in an accountability initiative where you will receive support and encouragements over a two week period?
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Yes, send me details
No thank you
Required
CONTACT & CLOSING
Your first name please?
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Your answer
Anything else you'd like to mention?
Your answer
A copy of your responses will be emailed to the address you provided.
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