Online Mindful Self Compassion (SC-MSC) Short Course

Full Name:

Phone Number:

Email Address:

Address:

Occupation:

Age:

How did you find us?

What has brought you to this Mindful Self Compassion Short Course at this time? (Please include any current major challenges)

If there are current challenges, what has helped you be with these?

Please briefly describe any prior experience with meditation.

What challenges might come up in finding time for home practice each day?

Are there any stressful life circumstances or mental or physical health issues or medications that might make this course difficult for you at this time (e.g. recent loss or change, alcohol or substance use, relationship break-down, past or present trauma

Are you currently seeing a counsellor or therapist?

What strengths do you bring into learning something new like this?

Is there anything else that may be helpful for your teacher to know at this time?

Do you have any issues with wi-fi?

Do you have a private space in which to do the course where you will not be disturbed?

Do you need any assistance with technology?

Mindful Self Compassion (SC-MSC) Questionnaire