Tuesday evenings MBSR (2016)

Upcoming MBSR program in North Vancouver

Tuesday evening MBSR program starting October 4th, 2016:

NOTE: This section is full with a waiting list!

If you wish to be placed on the waiting list, please fill the form below. You will then be notified if a spot becomes available.

Participation in this MBSR program involves meeting for nine sessions, plus, an info/orientation session. Here is the breakdown of hours:

1. One info/orientation session (1.5 hrs)
2. Eight evening sessions (2.5 hrs with exception to first & last sessions that are 3 hrs).
3. One All-Day session (6.5 hrs).

All MBSR participants are required to attend the info/orientation session (free and open to all). The total hours that you will be getting, including the info session, are 29. Please see detailed schedule/location below.

A safe environment will be created to systematically explore the use of mindfulness to deal with pain, illness, and the demands of daily life. This will include guided instructions, short lectures, and space for group sharing and questions.

The program requires a commitment to attend the sessions and engage in the daily practices given.

Location:

Delbrook Plaza
3743 Delbrook
North Vancouver, V7N 3Z4

NOTE: All regular program sessions are held at Delbrook Plaza with the exception to the All-Day session (November 12), it will be held at Parkgate Rec Center, 3675 Banff Court, North Vancouver. The detailed schedule of dates/locations will be e-mailed to you upon registration.

MBSR Schedule (2016):

Session

Session 1
Session 2
Session 3
Session 4
Session 5
Session 6
All-Day
Session 7
Session 8

Date

Tuesday, Oct. 4
Tuesday, Oct. 11
Tuesday, Oct.18
Tuesday, Oct. 25
Tuesday, Nov. 1
Tuesday, Nov. 8
Saturday, Nov. 12
Tuesday, Nov. 15
Tuesday, Nov. 22

Time

6:00 pm - 9:00 pm *(Three hour class)
6:00 pm - 8:30 pm
6:00 pm - 8:30 pm
6:00 pm - 8:30 pm
6:00 pm - 8:30 pm
6:00 pm - 8:30 pm
10:00 am - 4:30 pm ** (Extended session)
6:00 pm - 8:30 pm
6:00 pm - 9:00 pm * (Three hour class)

*Please make note of the dates in asterisks as they deviate from the regular schedule.
** All day session will be held on November 12th in the 2nd Floor Multipurpose Room 125 at
Parkgate Rec Center, 3675 Banff Court, North Vancouver.

Info/orientation session:

All MBSR participants are required to attend an info/orientation session.

Please choose ONE of the following dates/location (indicate your choice in the registration form at the bottom of this page):

Date	Time	Location	Address	Registration status
Tuesday, August 30	6:30 PM to 8:00 PM	North Vancouver	District Library (Edgemont Village) 3045 Highland Blvd.	Closed
Thursday, Sept. 8	7:00 PM to 8:30 PM	Downtown Vancouver	Listel Hotel 1300 Robson Street	Closed
Saturday, Sept. 10	10:30 AM to Noon	West Vancouver	St. Stephen's Pavilion 885 22nd Street	Closed
Tuesday, Sept. 27	6:30 PM to 8:00 PM	North Vancouver	District Library (Edgemont Village) 3045 Highland Blvd.	Closed

NOTE: If you were unable to attend any of these info/orientation dates, please contact me to make alternative arrangement (info@drkasimalmashat.com).

Fee:

$450 (includes MBSR booklet and mindfulness audios)

Helpful Fee Info:

I am a Registered Psychologist with the College of Psychologists of BC. Some Extended Health plans cover Psychologist Services. Otherwise, non-reimbursed Psychologist fees are tax deductible according to Canada Revenue Agency.

Payment method:

INTERAC e-Transfer (preferred), cheque, money order, or cash.

For INTERAC e-Transfer use info@drkasimalmashat.com.

Payment Options:

A minimum of $50 is due upon the completion of the form below. You can then pay the remaining balance by October 4th. Or, you can just make one payment of $450 upon the completion of the form.

You can also contact me if you need to make a special payment arrangement.

Refund policy:

Refunds for this MBSR program are provided for cancellations made prior to the MBSR session #1 (i.e., before Tuesday, October 4th), less a $50 processing fee. After that, no refunds will be issued unfortunately. Thank you for your understanding.

How to register:

To enrol, please fill the form below. Your application will then be reviewed, and you will be notified of your registration status within two business days.

If your registration form is received after the class is full, you will be placed on a waiting list.

The information below is only viewed by me (Dr. Kasim Al-Mashat) and is confidential. As a Registered Psychologist, I adhere to the highest standards of practice.

* Indicates required field

Name *

First

Last

Email *

Phone Number *

If you have attended one of the previous MBSR info sessions, please indicate when/where. Otherwise, indicate "not applicable". *

What is your date of birth (Day/Month/Year)? *

Is it okay to leave you a voicemail on the phone number you have listed (if needed)? *

Address *

How did you hear about this? (Please specify) *

Any previous meditation experience? *

Do you have close friend(s) and/or family in the area? *

How is the quality of your sleep? (please describe) *

Do you take prescription medication? (If yes, please list) *

Have you experienced any recent and significant changes due to: *

Medical/health matters. Psychological matters. None

If applicable please describe any recent significant medical and/or psychological changes. Otherwise, indicate "not applicable". *

Any previous overnight hospitalization? *

If you answered yes to the above question, please elaborate. Otherwise, indicate "not applicable". *

Have you experienced any of the following in the past (check all that apply): *

Considered and/or attempted suicide. Have urges to harm someone. Have experienced panic attacks. No, I have not experienced any of the above.

Please elaborate on the above question, or indicate "not applicable" if you selected "No". *

Do you have a history of substance abuse? *

If you answered yes to the above question, please describe how often and what type of substance(s). Otherwise, indicate "not applicable". *

What do you consider to be your strengths? (please list at least three) *

Emergency contact name *

Emergency number *

GP and clinic name *

Currently seeing a counsellor or psychologist? *

Method of payment? *

Payment options for the Tuesday evenings section, in North Vancouver, starting October 4th: *

Anything else you want me to know: *

Refunds for this MBSR program are provided for cancellations made prior to session #1 (i.e., by Tuesday October 4th), less a $50 processing fee. After that, no refunds will be issued unfortunately. Thank you for your understanding. *

Yes, I have red and agree with the refund policy

Please note: If you do not hear back from me within two business days after you submit the application, it means that your submission did not go through. You can double check by e-mailing me at info@drkasimalmashat.com *

Yes, I understand.

Submit

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