* Practice history and InspirationPlease describe your practice history and inspiration for attending this program.
* Medical conditionsWhat current or past medical or physical conditions are important for us to know about? Would any of this prevent you from doing chores during the program?
* Inpatient careHave you ever received inpatient care for psychiatric, mental health, or addiction issues? If yes, please describe:
* ConcernsDo you have concerns about engaging in intensive meditation practice at this time? Do others close to you (such as medical professionals, mental health professionals, or family members) have concerns?
* MedicationsWhat prescription medications are you taking now—or have taken in the past six months—for physical, psychiatric, mental health, or addiction issues?
* AllergiesDo you have any serious allergies (e.g. bee stings, penicillin, nut allergies, etc.)? If yes, please specify and explain how we should best respond in the event of a medical emergency.
* Dietary RestrictionsPlease list any dietary restrictions, allergies, and intolerances. Please also indicate if exposure would require medical attention (i.e. anaphylaxis due to peanuts).
* Additional CommentsIs there anything else we need to know about your registration?