New Student Form – Entering the Stream

Welcome! Before beginning your 8-week Zen meditation and mindfulness course, please fill out the form below. This will help you clarify your goals and intentions for the course, and help us support you in your experience of Zen practice. Many thanks!

First, please read our Student Agreement here, and agree to the terms.

Agreement*
I have read and agree to the Student Agreement.*
Name*
First Last
Email*
Location*
Have you practiced meditation, mindfulness, and/or Zen techniques before? Please give the dates and length of any previous experience.*
What do you intend or hope to get out of this course?*
What current stressors are you facing?*
Are there experiences you've had in the past that are still causing you stress?*
Do you have a history of trauma, and if so, are you actively experiencing symptoms that feel connected to that trauma? (Examples include flashbacks, nightmares, and having difficulty with attention.) If this is relevant to you, please feel welcome to come schedule a free call with me (at http://enteringthestream.as.me), to give you some extra support in getting started with a trauma-safe orientation toward your Zen meditation and mindfulness practice. Many thanks!*
Are you currently seeing a therapist or counselor, and if so, do they know you'll be taking this Zen meditation and mindfulness course?*
Are you currently taking medications for any physical or psychological conditions? If so, please share them below.*
Are there any other health considerations that you think we should be aware of (including any history of depression and/or self-harm)?*
What internal and external resources do you have in your life that offer you some support and bring you joy? :)*
Please include an Emergency Contact:*
Is there anything else you'd like us to know at this time?

Thank you so much!

If you have any questions, please email support@enteringthestream.co.