Personalized Meditation Questionnaire

Please copy this form into your email or Word document.

Please type in the things you want changed or eliminated from your life…bad habits, negative thoughts, etc.

Then send them to laney.t@comcast.net with MEDITATION in the subject line.  Be as detailed as possible.

 

Name:

Date:

Phone No.:

Email Address:

The name you prefer as I will be using it in the recording:

 

What makes you calm and relaxed…..beach, mountains, etc.?

 

Habits/concerns that you would like to change or eliminate:

 

Name the things you are thankful for.  Be specific.