FSTU Online Training Application Form Extended

First Name

Last Name

Email

Phone

Address 1

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City

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Date of Birth

Birth Country

Education

Are you currently seeing a psychotherapist?
YesNo
Please describe the situation.

Have you ever been under psychiatric care?
YesNo

Please describe the situation.

Have you ever been prescribed any kind of psychiatric treatment?
YesNo

Please mention what type of treatment, how long have you been under treatment and when was this happening.

Have you been diagnosed with any chronic illness, are you experiencing any kind of physical chronic pain?
YesNo

Please describe the situation.

Are you currently taking any medication?
YesNo

Please describe the situation.

What previous trainings / workshops related to Meditation & Healing have you attended?

Are you working with people, either with individuals or groups?

What are your intentions for this training and why is this valuable for you now?

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