* 1. How did you first become interested in Mindfulness and Meditation?

* 2. Have you been interested in meditation or mindfulness training, but haven't been sure how to get started?

* 3. Have you started a mindfulness or meditation practice, and struggled to keep it consistent?

* 4. Has a doctor, therapist, nutritionist or partner recommended meditation as a way to deal with stress?

* 5. What do you wish to accomplish through mindfulness coaching?

* 6. What is your name?

* 7. Where are your located?

* 8. At what email address would you like to be contacted?