Mindfulness Courses for Healthcare Professionals – Booking Form

Share with FriendsShare on FacebookTweet about this on TwitterShare on Google+Pin on Pinterest

Please use the booking form below. If you have any further queries about the mindfulness courses, please contact Julia Wallond on 07977 045 303 or Miro Cansky on 07765 515 662.

For fees and further details, see the Mindfulness Courses for Healthcare Professionals page.

1. Please give us some details about yourself.

I'm booking a place on:

Name

Email

Phone Number

How did you hear about this course? (leaflets,
Google, word of mouth, BeMindful website etc.)

What is your main reason for participating in
the mindfulness course?

Any previous experience with mindfulness
meditation or any other type of meditation?

Do you have any physical, medical or mental
health condition that we should be aware of?
(Answering yes does not necessarily exclude
you from attending the course.)

Are there any particular stressful elements
in your life at present? (Significant changes in
your circumstances, e.g. relationships, work,
where you live, health).

Are you aware that participation on the course
requires approximately 30 minutes of practice
a day, for 6 days a week for the duration
of the eight weeks?

2. PLEASE NOTE:

Mindfulness-based approaches have been found to be effective in promoting health and wellbeing for individuals facing a wide variety of challenges. However, these courses may not be an appropriate choice for you at this time.
This may be the case if you are dealing with:

  • An acute medical condition requiring frequent intervention or treatment.
  • Substance abuse or dependence (currently or within the past year).
  • Psychological issues including: suicidality, psychosis, trauma, severe depression or other major psychiatric diagnosis.

Mindfulness-based approaches are not psychotherapy, and are not a substitute for mental health counselling, medical care or substance abuse treatment. If you feel that any of the above health conditions apply to you, you are welcome to discuss your specific situation with us by contacting us here. We realise the personal nature of this information and we hold your responses in confidence. Please note that final decisions about participation in the course will be made by the course teachers.

Confirmation:

I have read the above information and understand that my application will be considered only after paying a deposit of £50. I am aware that benefiting fully from the course requires regular attendance on the sessions and regular home practice.

Please tick the box


3. Please Pay Your Deposit

The full price of the course is £250 – this fee includes eight mindfulness sessions, a course book ‘Mindfulness – Finding Peace in a Frantic World’ (including a CD with guided meditations), and e-mail or phone contact support with your home practice (if needed).

After submitting your booking form, please use the secure Paypal payment button below to pay a deposit of £50. Your booking will be considered complete upon receiving your deposit. Alternatively, you can make cheques payable to ‘Miro Cansky’ and send them to:

Miro Cansky
13 Clifton Vale
Bristol
BS8 4PT

We will then confirm the receipt of your application and the deposit and if you wish, we can arrange a short telephone conversation, to give you an opportunity to ask any questions about the course. Once your booking for the course is accepted, the deposit is non-returnable and the balance of payment is due on the first session of the course. If, after paying your deposit, you realise that you cannot attend the course, we can arrange transferring the payment to a later course.

Pay Securely With Paypal (£50)