Guided Meditation Intake Form
With Heather Klemanski
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Email
example@example.com
Are you interested in virtual, in person or recorded Guided Meditation?
Virtual
In person at your home or office
In person within a studio setting
In person outdoors (park or trail)
Recorded Meditation
What are your goals for Guided Meditation?
Self-Compassion
Relaxation
Break a habit
Physical health
Peace of mind
Mindfulness
Mindset
Reduce stress/anxiety
Promote healing
Mental clarity
Emotional balance
Spiritual Awakening
Physical healing
Other
Additional information?
Which of the following meditation techniques most interest you?
Guided relaxation and/or imagery
Mindfulness (breathing techniques)
Compassion or gratitude focus
Mantra (internally or externally repeating a word or phrase)
Spiritual
What position would be best for your body and goals during meditation?
Seated on the ground or cushion
Seated in a chair or sofa
Fully reclined
Walking in nature
No specific/any
If comfortable, please share any spiritual beliefs / practices / affiliations you would like included. Is your belief a source of support to you?
What is the length of time for meditation? Is there anything else you'd like to share?
Submit
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