Your Name (required)
Your Email (required)
Reason for taking this course
Have you ever taken a Mindfulness Meditation class before?
If YES, when and with whom
What is your meditation experience level?
Never meditated before Tried meditation a few times Meditate irregularly Meditate regularly
How did you hear about the course?
From a Friend From a Flyer From the Teacher Online Other
What is your current stress level?
Low Moderate High-but I enjoy the challenge High-sometimes difficult to handle
Are there any medical conditions or disability that may be of concern while taking this course?
Are there any mental health conditions that may be of concern while taking this course?
Do you have a question or message about the course?
To assure your spot, please write your check to: Andrea Colombu LMFT and deliver or mail to: 23a Orinda Way, Orinda CA 94563
Address: 6536 Telegraph Ave #B-205, Oakland CA 94609
Phone: (925) 212-2669
Address: 1615 Bonanza St Suite 407, Walnut Creek CA 94596