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Mindful-Self Compassion Background Information Form

Please provide the following background information to help your teacher(s) assess if MSC will be helpful to you at this time and to support you during the program. This information will only be read by the course teacher(s). If you feel uncomfortable answering any questions, please note this below, and we can have a private conversation before the program begins. Leaving a question blank will have no impact on inclusion in the program.

  • I understand that my participation in this program is entirely voluntary and I am free to withdraw at any time without penalty or prejudice, except for the non-refundable course fee. For 8 week course participants, I am planning to participate in the entire course (including the 4- hour retreat), and to practice mindful self-compassion at least 30 min/day (formally or informally). I also understand that I am responsible for my personal safety and wellbeing and will practice self-care throughout the program.
  • This field is for validation purposes and should be left unchanged.

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Accredited Member Australian Association of Social Workers (Member No. 440837)
Accredited Mental Health Social Worker
Trained Teacher in Mindful Self-Compassion, Center for Mindful Self-Compassion, University of California San Diego

Medicare Provider under the Better Access to Mental Health Care Program

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