Contact Details

Ananda Programmes Greystones,
Co. Wicklow,
Ireland

Links:

“Your intentions set the stage for what is possible”

Jon Kabat-Zinn

MBSR Application Form

Should you wish to apply for an MBSR Course, please use the online form below. Alternatively, if you prefer to complete the form offline you can download the PDF File, complete the form and post it to Ananda.

Download PDF version.

Mindfulness Based Stress Reduction (MBSR) 8 week Programme Initial Contact Form

This information is obtained to assess suitability and to tailor the programme to meet your needs. This information is held strictly in confidence and if you need to discuss any aspect of this Initial Contact Form please do not hesitate to contact Anne Twohig.

Name:
Address:
Phone No.:
Email Address:
Date of Birth:
Occupation:
MBSR Programme course dates you wish to attend:
Reason for attending:
What benefits do you hope to get from attending this MBSR programme?
Have you previous experience of Mindfulness/Meditation? If yes please give details:
Have you any physical or mental health difficulties that you would like me to be aware of? For example, anxiety, depression, bi-polar, eating disorders, hearing or sight impairment, wheel chair user. If yes please give details:
Are you presently on any medication that I need to be aware of? If yes please give details:
How did you hear about Ananda and this MBSR programme?
Any other relevant information:
Date: