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Free Mindfulness Check Template

Free mindfulness self-check — five awareness facets scored separately, with an AI report matching practice suggestions to your weakest facet.

~7 min
5 scored facets
AI PDF Report
AI Consultant
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Free mindfulness self-check — five awareness facets scored separately, with an AI report matching practice suggestions to your weakest facet.

Disclaimer: this page and its AI report are for self-reflection and process reference only. They do not constitute medical, psychological, financial, legal or safety advice. Consult a qualified professional when needed.

Methodology: items are a structural adaptation of widely used frameworks, not an official version; scoring is indicative, not diagnostic.

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About this template

Mindfulness is a set of trainable facets, not a single trait: observing, describing, acting with awareness, accepting without judgment and non-reactivity. This check scores five facets separately and the AI report matches practice suggestions to the weakest one — so MBCT teachers and clients stop guessing where to begin.

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Live Preview

Sample form and AI report preview (fillable once the app is published).

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Fill it in to see how responses flow.
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Sample AI report with scoring visuals and recommendations, printable as a PDF.
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Scan the QR on the report to start an AI consultant chat.
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What's Included

The observing, describing and non-reacting facets it scores.

1

Five-facet framing

Observing, describing, acting with awareness, non-judgment, non-reactivity.

2

Facet chart report

Shows which awareness muscle is strongest and weakest.

3

Practice prompts

Suggests where to start — before or alongside formal meditation.

4

Non-clinical tone

Works for wellness programs as well as therapy.

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How It Works

From copy to a mindfulness snapshot in four steps.

1

Copy the template

Import the check with scoring and report — free.

2

Adapt wording

Keep it secular or add practice-specific items.

3

Clients complete it

Seven minutes on any device.

4

Follow the profile

Choose the first practice from the weakest facet.

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Who Is This For

Who it suits — teachers, therapists or practicing individuals.

1

MBCT & mindfulness teachers

Place students at the right starting depth.

2

Therapists using acceptance work

Objectify non-reactivity before homework.

3

Wellbeing program leads

A pre/post measure for eight-week courses.

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Key Features

What makes this mindfulness check reflective, not just scored.

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Sample Questions Inside

The five-facet awareness items — the live check charts each facet and points to where practice should begin.

  1. I notice sensations in my body without trying to change them. (1-5)
  2. When I have distressing thoughts, I judge myself for having them. (reverse, 1-5)
  3. I rush through activities without being attentive to them. (reverse, 1-5)
  4. I can watch an emotion rise and pass without acting on it immediately. (1-5)
  5. I describe my feelings well to other people. (1-5)
  6. When something pulls my attention, I bring it back gently. (1-5)
  7. Which moment of your day could hold the most awareness? (open)
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Frequently Asked Questions

Do I need to meditate to score well on mindfulness?
No — the facets measure everyday awareness and non-reactivity, not sitting practice; someone with no meditation history can score high on acting with awareness.
Is this the official Five Facet Mindfulness Questionnaire?
No — it is an original item set inspired by the widely used five-facet framing; scores are indicative self-reflection, not a diagnosis.
Which facet should be trained first?
Usually non-judgment — self-criticism blocks everything else, and the report flags it when it stands out.
Is it free to use?
Yes — copy the check, scoring and AI report into your FormLM workspace at no cost.
Can courses use it pre and post?
Yes — eight-week programs commonly retake at start, midpoint and close to show facet movement.
What does the AI report suggest?
Concrete starting practices matched to weak facets, phrased for discussion with a teacher or therapist.

Know which awareness muscle is weak

A five-facet mindfulness check with practice-matched AI feedback — free to copy.