Online Meditation Coaching Request

Fill out the form below to get started. We will be notified and will contact you shortly.

First Name

Email Address

Last Name

Phone

I am interested in the following Meditation Program(s):

Body, Mind and Soul Meditation. 5 Session Package by Wakelyn Malitz

Primordial Sound Meditation. 4 Sessions Package by Viviana Robayo

Date of Birth

Place of Birth (Required for PSM Program only): City, State/Province and Country required

Time of Birth (Required for PSM Program only):

Have you ever been instructed in a Meditation Technique?

Yes

If yes, which technique?

Tell us more about your meditation practice: Have you practiced Meditation before? How often do you practice?

Tell us how you found out about the Austin Mindfulness Center:

My decision to learn Meditation is a personal decision. I have not been made any promises or warranties that I will receive any benefits or specific results. I understand Meditation is not a substitute for treatment or services ordinarily provided by health care professionals for physiological or psychological conditions. I further understand that any instruction given to me during the PSM is for me personally and may not be appropriate for others. In consideration for teaching Meditation, I hereby agree to hold the Austin Mindfulness Center, and their officers, agents, and employees harmless in any claims brought by me, or on my behalf, which contradict the above. My selection "Yes, I agree" below constitutes my acceptance of the conditions expressed in the agreement.

Select an option

Yes, I agree

No I do not agree

Online Meditation Coaching Request

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