Assessment Form (MBSR) Name First Last Email PhoneCourse Date MM slash DD slash YYYY Do you know anything about Mindfulness?Please give detailsWhat is your main reason for wishing to participate in this Course?Although this is not a therapy group it is helpful to know if there any significant personal issues going on in your life.If you become upset during sessions, as the teacher I encourage my students to create some space, switch off their camera and use their breath as an anchor to focus attention. How else would you like to be supported?