Topic 8. Pre-Course Questionnaire

Have you practiced relaxation before?

If yes, briefly describe your relaxation practices.

Have you practiced meditation before?

If yes, which types of meditation have you practiced?

Other? If not included in the list above.

If so, how frequently do you practice?

On a scale of 1 to 10 how much Physical stress do you experience? (1= minimal, 10 = extreme)

Please enter a number from 1 to 10.

On a scale of one to 10 how much Emotional stress do you experience?

Please enter a number from 1 to 10.

On a scale of one to 10 how much Mental stress do you experience?

Please enter a number from 1 to 10.

On a scale of one to 10 how much Spiritual stress do you experience?

Please enter a number from 1 to 10.

What are you hoping to gain from the Relaxation Meditation Course?

Do you have any other comments?

Your Name

Your Email