Mindful Monday Series Application
Thank you for your interest in the program and for taking the time to answer these questions. The following questions will let us know how ready you are for this course!
1. When you think of mindfulness, what do you think of?
2. Do you struggle with emotional and stress eating?
Yes
No
3. When you are bored, do you find yourself reaching for food?
4. How old are you?
Under 18
18 - 25
25 - 45
45 or more
5. Gender?
Please Select
Male
Female
6. What do you wish to gain out of this 4 week program?
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Name
First Name
Last Name
Submit
Should be Empty: