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Tokyo Stress Reduction

Mindfulness and Yoga-Based Stress Reduction

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Contact Information

Contact Information will be kept strictly confidential. It will not be shared or used for any purpose other than application to the 8-WEEK MINDFULNESS-BASED JOY PRODUCTION ONLINE COURSE.

First & Last Name *

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State/Province

Country

Phone *

Personal Information

Personal Information will be kept strictly confidential. It will not be shared or used for any purpose other than application to the 8-WEEK MINDFULNESS-BASED JOY PRODUCTION ONLINE COURSE.

Occupation *

Nationality *

Relationship Status *

Do you have children? *YesNo

How did you learn about this 8-WEEK MINDFULNESS-BASED JOY PRODUCTION ONLINE COURSE? *

What is you main reason for participating in this program? *0 / 60

If you currently have a meditation practice, please describe:

Are there any physical injuries or conditions that may affect your participation? *YesNo

If Yes, please describe: 0 / 60

Are there any emotional or psychological conditions that may affect your participation? *YesNo

If Yes, please describe: 0 / 60

Are you currently in psychological or psychiatric treatment? *YesNo

If Yes, please describe: 0 / 60

Are you currently taking prescription medication? *YesNo

If Yes, please describe: 0 / 60

Do you have a history of substance abuse? *YesNo

If Yes, please describe: 0 / 60

Please list 3 personal goals you have for taking this online course. *0 / 60

Complete and Send

I understand that in this 8-WEEK MINDFULNESS-BASED JOY PRODUCTION ONLINE COURSE I will be engaging in mindfulness-based and yoga-based methods for stress reduction. These methods have been shown to be helpful in reducing stress and increasing well-being, but are not a replacement for professional medical care. Results will vary among participants. I understand that if for any reason I feel it unwise to engage in these techniques in the weekly sessions or on my own, I am under no obligation to do so, nor will hold instructor Patrick Mitchell liable for any injuries or harm incurred as a result of participating in the program. *YesNo

Signed *

Date *

free orientation session

free orientation session

Name(required)

Email(required)

Website

Message

Contact Information

Contact Information will be kept strictly confidential. It will not be shared or used for any purpose other than application to the 8-WEEK MINDFULNESS-BASED JOY PRODUCTION ONLINE COURSE.

First & Last Name *

Email Address *

Confirm Email Address *

Street Address *

City *

State/Province

Country

Phone *

Personal Information

Personal Information will be kept strictly confidential. It will not be shared or used for any purpose other than application to the 8-WEEK MINDFULNESS-BASED JOY PRODUCTION ONLINE COURSE.

Occupation *

Nationality *

Relationship Status *

Do you have children? *YesNo

How did you learn about this 8-WEEK MINDFULNESS-BASED JOY PRODUCTION ONLINE COURSE? *

What is you main reason for participating in this program? *0 / 60

If you currently have a meditation practice, please describe:

Are there any physical injuries or conditions that may affect your participation? *YesNo

If Yes, please describe: 0 / 60

Are there any emotional or psychological conditions that may affect your participation? *YesNo

If Yes, please describe: 0 / 60

Are you currently in psychological or psychiatric treatment? *YesNo

If Yes, please describe: 0 / 60

Are you currently taking prescription medication? *YesNo

If Yes, please describe: 0 / 60

Do you have a history of substance abuse? *YesNo

If Yes, please describe: 0 / 60

Please list 3 personal goals you have for taking this online course. *0 / 60

Complete and Send

I understand that in this 8-WEEK MINDFULNESS-BASED JOY PRODUCTION ONLINE COURSE I will be engaging in mindfulness-based and yoga-based methods for stress reduction. These methods have been shown to be helpful in reducing stress and increasing well-being, but are not a replacement for professional medical care. Results will vary among participants. I understand that if for any reason I feel it unwise to engage in these techniques in the weekly sessions or on my own, I am under no obligation to do so, nor will hold instructor Patrick Mitchell liable for any injuries or harm incurred as a result of participating in the program. *YesNo

Signed *

Date *