COMING HOME to SELF

APPLICATION QUESTIONNAIRE

PLEASE NOTE: your completing this questionnaire is optional. However, it is designed to help ensure suitability for you of the particular process offered here. What you say here helps me attune to participants’ general requirements. Therefore, completing this sheet will be much appreciated – and treated in absolute confidence. Please enclose with your booking form. Many thanks.

 

Please summarise what it was it that attracted you to (delete as appropriate) these weekly sessions/this workshop?

 

 

To help maximise the rewards of this ‘coming home’ process for you, please give an idea of your expectations – and what you would like to gain from attending:

 

 

As a basic VISUAL imagination is required, do you consider yourself able to imagine visually?

(please tick ü one) YES UNSURE NO

 

 

Please summarise your experience of quietly sitting still/meditating/bringing your attention within yourself – stating whether you are comfortable with the prospect of engaging in this within a small group:

 

 

Do you have any experience of participating in small groups?

(please tick ü one) YES – considerable YES – a little NO – none at all

 

 

Please summarise what the phrase ‘coming home to self’ means personally to you:

 

 

 

Please summarise where you consider you are, in terms of your journey/process of ‘coming home to self’:

 

 

 

Are you, at present, experiencing any psychiatric/psychological difficult and/or treatment? PLEASE NOTE: previous experience of difficulty/breakdown is regarded as part of your journey.

(please tick ü ) YES NO If ‘YES’ to any of the above, please summarise:

 

 

 

If you have any experience of (psychological) therapy, is this current? (please tick ü ) YES NO

PLEASE NOTE: previous/current experience of therapy is likely to prove beneficial here.

 

 

 

If you have not experienced therapy, please summarise your own inner journey/process so far:

 

Have you any specific practical requirements?

 

 

 

Is there anything else you wish to say regarding your participation in this group?