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.