Student Information Form

Name *

First

Last

Participant Cell Phone Number *

Email *

Parent/Guardian Cell Phone Number (if under 18)

How did you hear about the course? *

Contact

KoruMindfulness.LI@gmail.com

Name *

Email *

Phone

Preferred Date & Time

Comment or Message

Comment

Contact Information

KoruMindfulness.LI@gmail.com

If you choose to view this website, you understand that no health care service, psychotherapy, or professional counseling of any kind is offered via this website. Information on the site should not be used in place of a call, visit or consultation with, or the advice of, a licensed healthcare or mental health professional should you require one. Please call or see a licensed healthcare or mental health professional for any healthcare-related questions or advice.

Privacy Policy

A Therapist Website by Brighter Vision | Photo credit : Stacie Errera