Mindful Practice Questionnaire Mindful Practice Questionnaire Name* First Last Phone number*Email Address* Why did you sign up for Mindful Practice? What do you hope to get from it?*What exposure have you already had to mindfulness practices such as meditation and yoga?*Have you ever or do you now have a regular mindfulness practice?*Are you able to attend all weeks of the workshop?* Yes No Which campus is your Mindful Practice Workshop on?* Charles River Campus Medical Campus If not, which weeks are you not able to attend?*Are you willing to commit to a daily home practice of 30 minutes per day for 5 weeks?* Yes No Do you have any physical health concerns or injuries that might impact your ability to sit on the floor (rather than on a chair) or to participate in gentle yoga exercises?*Are you currently experiencing depression or significant anxiety or being treated for these or any other emotional/psychological issues? (If you would prefer to discuss this with me rather than share this in writing, please contact the FSAO office to set up a time to speak with me either by phone or in person).*Do you have any concerns about participating in this course?*Is there anything else that you think would be helpful for me to know about you?*