It’s confidential and will only be seen by your teacher.
Name *
Age *
Profession/Job Title
Have you ever had a prolonged physical illness or health condition? *
Do you suffer from hearing problems? *yesno
Do you suffer from back pain? *yesno
Have you undergone psychoanalysis or treatment for mental illness? *
Are you currently seeing a psychiatrist, psychologist or counsellor? If so, how often? *
Please describe your present state of physical and mental health *
Are you currently taking any prescribed medication or undergoing any medical treatment? *
Are you currently taking any non prescription drugs? (eg. cannabis) Please state frequency & when last taken *
I confirm that the information provided here is a true representation of my personal details and health history and is provided by me in requesting personal instruction with a qualified TM teacher. I understand that TM is a meditation technique and is not a medical treatment or cure for any health condition.
I understand that, following my personal instruction, a series of three meetings are vital to gain a full understanding of my experiences of meditation and to derive maximum benefit from TM I need to attend the whole course as outlined to me.
I understand that although TM is a very simple technique it can be easily misunderstood and its effectiveness depends on skilled instruction by a professional teacher. I therefore agree that I will not disclose to anyone the mantra I receive or its instructed use. Nor will I attempt to instruct others until I have personally received the training necessary to become a qualified teacher.
I agree to the above - please tick *