One-on-One Mindfulness Sessions Form
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One-on-One Mindfulness Sessions
with Karen Sothers, M.Ed., E-RYT

One-on-One Mindfulness Registration Form:

Welcome! I’m grateful you are beginning this One-on-One mindfulness journey.

As a first step, please take a few moments to complete the registration form below. This information helps me understand your intentions, experiences, and any specific areas you would like support with so that our time together can be personalized and meaningful for you.

Please complete the form and return it to Karen Sothers by clicking the “Send” button at the bottom of this page.

⚠️ Important: Please complete the form in one sitting. If you leave this page before submitting the form, your information will not be saved and you will need to re-enter it. Your responses will be securely transmitted to Karen over an encrypted connection once you click “Send.”

You are welcome to be brief or more detailed in your responses — whatever feels most helpful and comfortable for you.

If there is any information you prefer not to record in writing, we can discuss it during your first session.

Please be assured that your information will remain confidential and will not be shared with anyone else without your permission.

Thank you for taking the time to complete this form. I look forward to working together.


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    To best support you during your One-on-One Mindfulness Training, it is helpful to have a general understanding of your current health conditions, past health history, and significant life events.

    Are you currently engaged with (or have you been in the past) counseling, therapy, psychotherapy or psychiatric care?
    - - If yes, please describe

    Do you have any experience with yoga?
    - - If yes, please describe

    Do you have any experience with meditation or relaxation methods?
    - - If yes, please describe


    Do you have children?

    Do You Smoke? -- If yes, how much

    Sleep quality
    Hours per night

    Do you have challenges with falling asleep?

    Do you have challenges with going back to sleep if you wake up too early?

    Do you consume alcohol?
    - - If yes, Avg. drinks per week

    Personal Goals for One-on-One Mindfulness Training *


    When you are ready to submit your One-on-One Mindfulness Registration Form to Karen, please click on the SEND button below and your information will be transmitted over an encrypted connection.

    IMPORTANT: After clicking SEND below, please wait a moment for confirmation that your message has been sent before you navigate away from this page.