Mindfulness Self-Assessment Questionnaire
Reflect on your mindfulness habits and awareness by completing this self-assessment questionnaire.
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First Name
Last Name
Email Address (optional, for follow-up or results)
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How often do you intentionally focus your attention on the present moment?
*
Never
1
2
3
4
Always
5
1 is Never, 5 is Always
How aware are you of your thoughts and feelings as they arise?
*
Not at all aware
1
2
3
4
Extremely aware
5
1 is Not at all aware, 5 is Extremely aware
When you experience difficult emotions, how likely are you to observe them without judging yourself?
*
Very unlikely
1
2
3
4
Very likely
5
1 is Very unlikely, 5 is Very likely
How frequently do you find your mind wandering to the past or future rather than staying in the present?
*
Very frequently
1
2
3
4
Rarely
5
1 is Very frequently, 5 is Rarely
To what extent do you practice acceptance of things as they are, without trying to change them immediately?
*
Not at all
1
2
3
4
Completely
5
1 is Not at all, 5 is Completely
How often do you notice sensations in your body, such as breathing or muscle tension, throughout the day?
*
Never
1
2
3
4
Very often
5
1 is Never, 5 is Very often
How would you rate your overall mindfulness in daily life?
*
1
2
3
4
5
Which mindfulness practices do you engage in regularly? (Select all that apply)
Meditation
Breathing exercises
Body scan
Mindful walking
Journaling
None of the above
Other
Please share any insights or reflections you have about your mindfulness journey.
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