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Intake Form

Thank you for your interest in Kindness Reclaimed Club!

I'm so glad you're considering joining this journey. To ensure this program is the right fit for where you're at right now, I ask everyone to complete this brief form. It helps me understand what you're looking for and make sure I can offer the support that will be most helpful to you.

Please note that each program is limited to 6 participants to maintain an intimate, supportive space. If this round fills up, you're welcome to join the waitlist—you'll be the first to know when the next program opens.

I'll review your responses and be in touch soon to confirm your spot or discuss any questions.

What is your name?

What is your email address?

What motivated you to enroll in this Self-Compassion course

What are your expectations for this course?

The current online intake will be running Fridays, 10am-12pm AEST
Starting October 24, 2025 | Ending December 5, 2025 Are you able to attend all the sessions?

The current online intake will be running Fridays, 10am-12pm AESTStarting October 24, 2025 | Ending December 5, 2025 Are you able to attend all the sessions?

If no, please share more details on which session/s you are unable to attend.

What personal or professional goals are you aiming to achieve by improving your Self-Compassion?

What changes do you anticipate in your life after completing this Self-Compassion course?

What areas of life feel the most challenging to you at the moment?

Can you recall a recent situation where you showed yourself compassion? What did that look like?

When you feel difficult emotions (e.g. sadness, anger, anxiety), how do you usually cope?

Are there any areas of your life where you want to experience more ease, acceptance, or self-kindness?

What specific challenges or patterns do you hope to address through practicing self-compassion?

Are you currently experiencing any physical or mental health challenges? If so, please specify.

Have you ever received treatment related to emotional or mental health (e.g., counseling, therapy, coaching)? If so, please describe.

Are you currently receiving any emotional or psychological support or taking any related medications? Please indicate here.

Do you have current or past thoughts of self-harm or suicide? Please explain if you feel comfortable.

Do you have thoughts of harm to others?

Do you use alcohol or drugs? If so, please specify the frequency and amount.

Do you have any additional questions or concerns you would like to discuss?

If this round has already filled up would you like to be added to the waitlist?

If this round has already filled up would you like to be added to the waitlist?

If anything about this program feels inaccessible to you, please let me know what changes would help. I can't promise all adjustments will be feasible, but your feedback helps me improve future offerings and I'll do what I can to support access.