Self-Compassion and Mindfulness

ALL ARE WELCOME - PHYSICIANS AND HEALTH TEAM/OFFICE STAFF

We have received many requests from our physicians to include your Health Team/Office Staff in the Virtual Mindfulness Group: Simple Techniques for Complex Times, a virtual program. We welcome you to invite your Health Team/Office Staff to participate. Please complete the registration information for Team member(s) in the fields below. Once registered each Team Member will receive their own Confirmation.

Please Note: if more than 1 person is registering for the program, all registrations must be included on this form.  If you register a member of your office team please make sure to use their email address so that they receive a confirmation email. If you wish to register more than two Office Team members please contact Nicole at - 516-277-4326.
Please enter Physician registration information in the fields provided below.

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1. First Name: (Required.)

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2. Last Name: (Required.)

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3. Email:  (Required.)

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4. Specialty (Required.)

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5. Organization (Required.)

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6. Designation: (Required.)

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7. Who is your Medical Malpractice Insurance Carrier (Required.)

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8. How did you learn about this program?  Please select all that apply (Required.)

Please enter Heath Team/Office Staff registration information in the fields provided below.

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9. First Name

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10. Last Name

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11. Email

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13. First Name

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14. Last Name

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15. Email

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