PRE-COURSE QUESTIONAIRE

Thank you for taking the time to answer these brief questions. The reason for this questionnaire is to make sure that everyone gets the most from this course. Also to make sure that it is suitable for you at this time.

First Name

Last Name

Email

Why do you want to participate in the Stress Reset?

Do any of the following apply to you?

If they do, it doesn’t necessarily mean that you can’t take the course. However we will need to have a talk about it on the phone before you commit to joining.

A recent traumatic event such as an accident, loss or unwanted separation

Are currently abusing substances

Have major depression or bipolar disorder

Have schizophrenia

Any other pre-existing psychiatric condition

None of the above

This course includes a daily exercise of approximately twenty minutes per day. A lot of people take this course because of stress and lack of time could be part of this. It is important that you find this time however or you won’t receive the full benefits of the course. People who have taken this course and who do the practices always report a reduction of stress and a feeling of more time created. With that in mind, can you commit to this time over the six weeks of the course?

Yes

Not Sure

Sometimes illness or a pre planned trip mean that you can’t attend one of the sessions. This is OK as long as you commit to a 15 minute phone call with the teacher and to continue with the home practices. You must be able to attend a minimum of four sessions. Are there any dates that you know of that you won’t be able to attend?