Please complete the following application for a place in our program (The Mindfulness Movement). Within 48 hours I will be in touch with you to book you in for your consultation.

I am really looking forward to speaking with you!

Anna
START
 
What is your name? *

 
What is your phone number plus country code? *

 
What is your email address? *

 
What is your job title? *

 
What methods or programs have you done before to try and reach your lifestyle/weight loss goals? *

 
What are you currently really struggling with? *

 
What sort of help or support do you feel you really need? *

 
What are your exact goals for the next 12 weeks? *

 
Are you motivated and committed to start something new? *

 
Please select which type of consultation will suit you best. Please note face 2 face consultations are only available in Amsterdam and telephone consultations are available globally. *


Thank you for completing your application form. Please click on the button below to confirm your application.
CONFIRM
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