NAMI家庭支持小组是：

• 一个为关心亲人心理健康的成年人提供的保密支持小组。
• 每次会议时长为90分钟，参与者免费参加。
• 由受过培训、有相似经验的组长担任引导者。
• 一个安全的环境，让你可以自由表达自己而不受评判。
• 包容性强——欢迎任何人参加，无论诊断结果如何。

报名信息 : Registrant Information

请如实填写您的信息，信息将被保密

We ask that all interested participants register individually for this group.

Name:姓名

Email: 邮箱

Phone Number:手机号码

Yes, it's okay to send me text messages including confirmations, changes, updates, and/or promotions. Message frequency varies. Message and data rates may apply. View our terms of service & privacy policy.

Address

这个小组专为那些照顾患有精神疾病的亲人的家庭成员而设立。请问您符合这个条件吗？

Yes:是
No. 否，请移步 NAMI 官网找到适合您的小组：You might be interested in some of NAMI's other programs. Please visit our website http://www.namimass.org for more information.

您亲人的诊断结果（如果有) : Diagnosis (if known):

您亲人的发病年龄:Age of onset

您亲人现在的年纪: Current age

请简单分享您的故事，或者任何您想要我们知道的信息: Please share your story and/or any additional information you feel is important for us to be aware of:

您是如何知道我们的信息的？: How did you hear about this class?

网站 NAMI Massachusetts Website
社交媒体（微信，instagram，等等）
邮件
他人推荐: Recommended by a friend, family member, or colleague
网络查找: Internet Search
其他: Other

NAMI 家庭支持小组指导原则: Group meeting guidelines.I understand the group guidelines and promise to abide by these guidelines:

NAMI家庭支持小组
指导原则
1. 准时开始和结束
2. 分享时间有限制
3. 绝对保密
4. 互相尊重
5. 为他人着想；不打断或独占发言
6. 讨论聚焦于当下
7. 对彼此的处境感同身受

NAMI Family Support Group Guidelines

1. Start and stop on time
2. Time limit for Check In
3. Absolute confidentiality
4. Be respectful
5. Be mindful of others; no interrupting
or monopolizing
6. Keep the conversation in the present
7. Empathize with each other’s situations

I have read and agree to the terms above.

紧急联系人信息 : Emergency Contact Information

紧急联系人姓名 : Name of Emergency Contact

关系: Relationship

电话号码; Phone Number

After submitting your registration form, one of the program leaders will be in contact with you shortly regarding the next steps in the registration process.

中文 NAMI 家庭支持小组

每个月第一个周三晚上19:30-21:00

Group Facilitators

肖念瑶（Vesper) - (she) NAMI Cambridge-Middlesex

王梓蔚（Ziwei）- (she/they) NAMI Cambridge-Middlesex

报名信息 : Registrant Information

紧急联系人信息 : Emergency Contact Information