MBSR Online Week 8 Questionnaire Form
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MBSR Online Week 8 Questionnaire

Please complete the following questionnaire and return to Karen by clicking on the send button at the bottom of this form.

Feel free to be brief or more detailed in your answers. The purpose of the questionnaire is to help you be clear about and committed to your personal mindfulness intentions.

Please be assured that Karen will not share your information with anyone else without your permission.

Note:  If you navigate away from this page before you click send, your data will be erased and you will need to start over.

    Optional: Your experience during MBSR can be inspiring for others to read who are interested in learning more about the benefits of the program. If it is okay for me to anonymously share your MBSR experience with others, please click YES below.
    Note: If you grant me permission to share your feedback, your name, age or any other identifiable features will not be used to protect your privacy.

    you have my permission to anonymously share my MBSR experience with others.

    When you are ready to submit your MBSR Week 8 Questionnaire to Karen, please click on the SEND button below and your information will be transmitted over an encrypted connection.

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