Course Application

Fields with an * are required


Thank you for your interest in attending a Mindfulness Program. Before we can book you in, an application form needs to be completed so we can ensure you are getting the right course for your current needs. To apply, please fill in the form below and we will be in contact with you. If you would prefer to chat, please call us on 0488 064 228.

Please notethese funded courses are available for Tasmanian adults (over 18) and are not suitable for those seeking professional development.


MINDFULNESS PROGRAMS AUSTRALASIA (MPA) 

Consent Form   - the legal bit to do before you give your personal information!

As part of providing this service to you, our MPA Facilitators will need to collect and record personal information from you that is relevant to your current situation, such as your name, contact information, some medical history and other relevant information. This collection of personal information enables MPA to offer these services to you, capture overall regional service provision and plan future service improvements. The information is kept securely. In the interests of your privacy, it is used only by your group facilitator and the authorised staff at MPA. A more detailed description is available in our “Privacy policy for management of personal information”, which can be downloaded here.

By checking the box below you acknowledge that you have read and understood this Consent Form and agree to the above conditions for Mindfulness Programs Australasia to record your information and use this for your health, safety, data collection and reporting, directly related to the MPA service.


I, (your name in Block Capitals)


Please note: If, after reading this form you are at all unclear about any of the information provided, please discuss these with your course facilitator, the MPA administration on 0488 064 228 or email your concerns to admin@mindfulnessaus.com.au. For any complaints please contact either Miranda on 0488 997 095 or Christine on 0427 824 759, and/or Primary Health Tasmania on 1300 653 169. You may also ask your facilitator for a Complaints/ Compliments form, or you may fill in the form online. We greatly appreciate your assistance.

The following questions should take about 5 minutes to complete – thank you!


Contact Details


The following ten questions ask about how you have been feeling in the last four weeks. For each question, click on the option that best describes the amount of time you felt that way. Answer all questions please.



The next few questions are about how these feelings may have affected you in the last four weeks. You don’t need to answer these questions if you answered ‘None of the time’ to all of the ten questions about your feelings:



Thank you for completing this form. If this has raised any difficulty for you please call Lifeline on 13 11 14. If you would like to start practicing mindfulness and other psychological strategies for wellbeing while you wait for us to get back to you click here. Please note that if you have applied for a waitlist, it might be weeks or months before we have a course available and contact you so please see your GP if you need more immediate support.