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MBSR Application

This form is necessary to complete prior to taking the MBSR (Mindfulness-Based Stress Reduction) program. All responses are confidential and read only by your MBSR teacher, to help her best support you while you participate in the program.

Preferred method of communication

The Mindful Journey, LLC is inclusive and respectful to all people, including LGBTQ+ persons. Answering the below question is optional.

Do you have any mental concerns or conditions including symptoms of anxiety, depression or psychosis?
Have you ever or currently thought of or attempted suicide?
Have you experienced any major averse, traumatic or extremely stressful life events that are currently affecting you?
Are you currently seeing a therapist or counselor?
Are you currently abusing alcohol or drugs?
Do you have a history of abusing alcohol or drugs?

Cancellation and Refund Policy:

All cancellation requests must be made in writing to The Mindful Journey: You must submit a request to cancel your enrollment and receive a refund no later than 14 days prior to the course start date to receive a full refund, minus a 10% administrative fee. Refunds will be processed within 30 days following the receipt request. If cancellation is requested less than 14 days prior to the course start date, you will be responsible for 30% of the cost of the program. Remaining funds may be credited to the same course scheduled within the next 18 months (locations vary). If the course price changes in the 18 months from the start of the course, you will be responsible for paying the price differential. All unclaimed credits expire at the end of 18 months from the start of the course. If a cancellation is made after the course start date, no refund or credit will be granted.

Please type your first and last name in the box above.

Thank you for taking the time to apply to the upcoming Mindfulness-Based Stress Reduction Course. Jessica will be in touch shortly with next steps. Please don't hesitate to contact us with any questions!

After submitting your application, please wait a few moments before navigating off this page for confirmation your application has been received.

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