Name
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First Name
Last Name
Email
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Phone
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(###)
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Do you have an existing mindfulness practice? Please detail below.
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What is your past experience with meditation? No experience is required.
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How do you feel about routine? Do you crave or resist it?
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How do you feel about specific assignments? Do you like to have exercises to complete (homework) to take the work deeper?
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When digesting information, do you prefer to read or listen?
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Do you tend to do your best thinking/processing when you are still and seated, or active and moving?
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When adopting a new behaviour, do you tend to stick with it, stick with it for a time and then drop it, or not even really adopt it in the first place?
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Are you skeptical as to whether mindfulness will be helpful for you? Why? It's okay to be honest here.
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Do you find it difficult to "quiet your mind"? How does this affect your work and personal life?
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What are your main goals in learning about mindfulness?
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If you could press a button and release 5 things from your life right now, what would they be? (these could be individual tasks, feelings, or whatever you like)
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What is the emotional state that you currently struggle with the most? This may be: Overwhelm, dread, anxiety, anger, etc.
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On average, how much time do you have each day to devote to your mindfulness practice?
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Less than 10 minutes
10 to 20 minutes
20 minutes to 45 minutes
I don't know
What is the most important thing you'd like to accomplish in working with Kyra?
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Do you prefer to conduct your sessions via Zoom or Telephone?
Zoom / Video
Phone / Audio
