Questionnaire for partecipants – Pian dei Ciliegi centro di meditazione Vipassana

In-Person Retreat Participants Questionnaire

Retreat title:

01/01/1970 - 01/01/1970

Full Name *

Email *

Date *

Have you participated in other Vipassanā meditation retreats? *

Have you had other meditation experiences? *

Are you currently being followed by a psychotherapist, psychologist or counselor? *

Have you ever been diagnosed with a mental disorder? *

Do you have a physical disorder that could be aggravated by sitting and walking meditation practice? *

Are there particularly burdensome situations for you in this period that could cause additional difficulty in your meditative practice? *

Is there any other information you think is useful for the teacher or manager? *

I, the undersigned [NAME], declare that all the information given is truthful and that I have not neglected to indicate important data. I relieve the Pian dei Ciliegi Association from any responsibility in case of physical, mental or psychological damage that may occur during my stay at the Pian dei Ciliegi Meditation Center.

Signature * By typing your full name you accept all terms of the declaration above.