Mindful Moment Pre Survey
Brought to you by CHOiCE Recovery Coaching
Name
First Name
Last Name
Email
example@example.com
Is this your first time attending a virtual meditation?
yes
no
Have you participated in any of the following before?
Guided Meditation
Breathwork
Sound bowl/sound healing
Yoga
Mindfulness Practice
None of the above
How familiar are you with meditation and mindfulness practices?
Very familiar
Somewhat familiar
Not familiar at all
What motivated you to sign up for this session?
Reduce stress
Improve emotional wellness
Support my recovery journey
Learn a new wellness practice
Improve focus and concentration
Sleep and relaxation
Curiosity
Other
What are you hoping to gain from this session? (please, tell us)
How would you rate your current stress level?
Very low
Low
Moderate
High
Very high
Which wellness topics interest you most? (select up to 3)
Stress management
Mindfulness
Breathwork
Sleep and rest
Managing anxiety
Building resilience
Relaxation techniques
Gratitude practices
Self-compassion
Is there a topic you would like us to explore in a future session?
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