Corporate Mindfulness Programs Intake Form

Company Information

Company Name

Company Industry

Company Size (Number of Employees)

Company Address

City

State/Province

Postal/Zip Code

Contact Person (Name & Title)

Contact Phone Number

Contact Email Address


Phone Number

Phone Number


Website

Current Company Culture & Challenges

What are the primary challenges your company is currently facing?

How would you describe your current company culture?

Are there any specific departments or teams experiencing particular challenges?

Have you implemented any wellness or stress-reduction programs in the past?

What are your company's goals for implementing a mindfulness program?

What are your key performance indicators (KPIs) or metrics you would like to see impacted by a mindfulness program?

Mindfulness Program Preferences & Options

Please select the services that interest you (check all that apply):

Mindfulness Program

Select

Introductory Mindfulness Workshops: (Brief overview of mindfulness principles and practices)

Ongoing Mindfulness Training Programs: (Structured programs with regular sessions)

 
  • 4-Week Program
  • 8-Week Program
  • 12-Week Program

Customized Mindfulness Programs: (Tailored to specific company needs and goals)

Mindfulness for Leadership Development: (Focus on enhancing leadership skills through mindfulness)

Stress Management & Resilience Training: (Techniques for managing stress and building resilience)

Mindfulness for Team Building & Collaboration: (Activities to improve communication and teamwork)

Mindfulness for Creativity & Innovation: (Practices to enhance creative thinking and problem-solving)

Guided Meditation Sessions: (Regular guided meditations for employees)

 
  • On-site
  • Virtual

Mindfulness App Integration & Support: (Guidance on using mindfulness apps)

"Mindful Moments" - Short, frequent mindfulness breaks: (Designed to be implemented throughout the working day)

Train-the-Trainer Programs: (For internal staff to lead mindfulness initiatives)

One on One Mindfulness Coaching

Retreats or Offsite Mindfulness Days

Program Delivery Preferences

What is your preferred day(s) and time(s) for sessions?

What is the approximate number of employees that would be participating?

Suitability & Customization Questions

What is your company's budget range for a mindfulness program?

What is the average length of a workday at your company?

Are there any specific accessibility requirements for your employees? (e.g., language, physical limitations, etc.)

Are there any cultural or religious considerations that should be taken into account?

What level of commitment can your employees realistically dedicate to a mindfulness program?

How would you like to measure the success of the mindfulness program? (e.g., surveys, feedback sessions, performance metrics, etc.)

Are there any specific topics or areas of mindfulness that you would like the program to focus on?

What is the general tech savviness of your employees? (Important for virtual or app based programs)

Do you have dedicated space for in person sessions?

Are there any known issues with internet connectivity for virtual sessions?

Additional Information

Please provide any additional information or comments that you feel would be helpful in designing a suitable mindfulness program for your company.

Do you have dedicated space for in person sessions?

Next Steps:

  • Thank you for completing this intake form. We will review your information and contact you to discuss your needs and develop a customized mindfulness program.
  • Would you like to schedule a preliminary consultation?

Signature

Signature:


Client Intake Form Insights

Please remove this client intake form insights section before publishing.


Let's break down this Corporate Mindfulness Programs Intake Form section by section to understand its purpose and the insights it aims to gather:

1. Company Information:

  • Purpose: This section establishes the basic identity of the client company.
  • Insights:
    Company Size and Industry: These factors help determine the scale and nature of potential challenges. A large company in a high-stress industry (e.g., finance, tech) will likely have different needs than a small non-profit.
    Contact Information: Essential for communication and follow-up.

2. Current Company Culture & Challenges:

  • Purpose: This is the core of the form, designed to understand the company's pain points and the reasons for seeking mindfulness training.
  • Insights:
    Primary Challenges: Reveals the specific issues the company wants to address (e.g., stress, burnout, communication). This helps tailor the program to their needs.
    Company Culture: Provides context for how mindfulness practices might be received and integrated.
    Past Wellness Programs: Understanding past experiences helps avoid repeating ineffective strategies and builds upon existing initiatives.
    Company Goals and KPIs: Clarifies the desired outcomes and provides a basis for measuring program success. It also allows you to align the program with the companies business goals.

3. Mindfulness Program Preferences & Options:

  • Purpose: This section outlines the services offered and allows the client to express their initial interests.
  • Insights:
    Service Selection: Indicates the client's preferred format and focus of the program.
    Program Delivery Preferences: Determines the practical aspects of program delivery (on-site, virtual, schedule, participant numbers). This is extremely important for logistical planning.

4. Suitability & Customization Questions:

  • Purpose: This section delves deeper into the company's specific needs and constraints, ensuring a good fit between the program and the client.
  • Insights:
    Budget: Determines the scope and intensity of the program that can be offered.
    Workday Length and Accessibility: Addresses practical considerations for scheduling and inclusivity.
    Cultural and Religious Considerations: Ensures sensitivity and avoids potential conflicts.
    Employee Commitment: Assesses the level of participation and engagement that can be expected.
    Success Measurement: Establishes clear criteria for evaluating the program's effectiveness.
    Specific Topics and Tech Savviness: Allows for program customization and addresses potential technical challenges.
    Space and internet connectivity: Ensures that the program can be delivered with out problems.

5. Additional Information:

  • Purpose: Provides an open-ended opportunity for the client to share any relevant information that may not have been covered in the previous sections.
  • Insights:
    Uncovers any unique or unforeseen factors that could impact the program.

6. Next Steps:

  • Purpose: Sets clear expectations for the follow-up process and encourages further engagement.
  • Insights:
    Indicates the client's level of interest and readiness to proceed.

Key Strengths of this Intake Form:

  • Comprehensive: Covers a wide range of relevant topics, ensuring a thorough understanding of the client's needs.
  • Structured: Organized into logical sections, making it easy for the client to complete.
  • Customizable: Designed to gather information that can be used to tailor programs to specific client requirements.
  • Insightful: The questions are designed to elicit meaningful responses that reveal the underlying challenges and goals of the client.
  • Practical: Addresses logistical and practical considerations for program delivery.

How to Use the Insights:

  • Program Design: Use the gathered information to create a customized mindfulness program that addresses the client's specific needs and goals.
  • Sales and Marketing: Use the insights to tailor your sales pitch and marketing materials to resonate with the client's challenges.
  • Client Relationship Management: Use the information to build a strong relationship with the client and ensure their satisfaction.
  • Program Evaluation: Use the identified KPIs to measure the success of the program and demonstrate its value.

By carefully analyzing the information collected from this intake form, you can develop effective and impactful corporate mindfulness programs that deliver real results.


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