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Intake Information Please complete the following questionnaire. This information will be discussed more thoroughly in session and used to determine goals for counseling. Name: Date of Birth: Address:
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To fill out what is mindfulness, follow these steps:
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Start by finding a quiet and comfortable space where you can sit or lie down.
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Close your eyes and take a few deep breaths, focusing on your breath as it enters and leaves your body.
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Pay attention to your thoughts and emotions without judgment. Notice any sensations or feelings that arise.
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Bring your attention to the present moment, observing your surroundings and the sensations in your body.
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Practice acceptance of whatever arises, without trying to change or control it.
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Allow yourself to fully experience the present moment, letting go of any distractions or worries.
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Maintain this state of mindful awareness for a few minutes or as long as desired.
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Take a moment to reflect on your experience and any insights gained from practicing mindfulness.
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Repeat these steps regularly to cultivate a mindfulness practice.

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Mindfulness is the practice of being present in the moment and paying attention to thoughts, feelings, and sensations without judgment.
Anyone who is interested in improving their mental well-being can benefit from practicing mindfulness.
To practice mindfulness, one can start by focusing on their breath, noticing when the mind has wandered, and gently guiding the focus back to the present moment.
The purpose of mindfulness is to cultivate a sense of peace, clarity, and self-awareness by being fully present in each moment.
There is no specific information that needs to be reported for practicing mindfulness, as it is a personal practice for mental well-being.
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