Death Cafe Contact Form

A place for strangers to gather together to discuss death, dying, grief and bereavement to:

  • Learn about enlightening possibilities for future deathcaring through storytelling
  • Share thoughts, reflections, stories, and ponderings in a welcoming space
  • Reduce fear of death and anticipatory grief
  • Make the most of our time left on earth
  • Feel deep connection and intimacy in our shared humanness 

A Death Café is a group directed discussion of death with no agenda, objectives or themes. Our objective is 'to increase awareness of death with a view to helping people make the most of their (finite) lives'.  

This is not a support group or a counselling session.  It is a respectful, life affirming, thought provoking conversation about a topic that is often shied away from!  Come talk about the taboo!! 

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Contact Information
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Name (first and last) *
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Monthly Newsletter
A monthly newsletter will be available monthly with a topic and supportive information around that topic.  A pdf copy will be available on the webite and emailed to you.  
Sign up here for the Newsletter!  This is the basis for our support group meeting discussions! 

Sign up Here: Newsletter!

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Balance Holistic Grief Support Group Consent

This consent form is designed to provide you with information about the grief support group and to obtain your consent to participate. Please read the following carefully and feel free to ask any questions before providing your consent.

Purpose of the Group:

The grief support group aims to create a safe and supportive environment for individuals experiencing grief and loss. Participants have the opportunity to share their experiences, receive support, and explore coping strategies in a confidential setting.

Key Group Features:

  1. Confidentiality: What is shared in the group stays within the group. Participants are expected to respect the confidentiality of others.

  2. Respectful Communication: We encourage open and respectful communication. Disagreements are normal, but participants are expected to express themselves in a way that respects others' feelings.

  3. Voluntary Participation: Participation in the group is entirely voluntary. Participants are free to withdraw at any time without any obligation.

  4. Peer Support: The group encourages peer support, with participants sharing experiences and providing comfort to each other.

Consent Agreement:

I have read and understood the information provided above. I voluntarily agree to participate in the grief support group with the understanding that:

  • I will respect the confidentiality of others in the group.
  • I have read and agree to the Support Group Guidelines
  • I am free to share as much or as little as I feel comfortable with during group discussions.
  • I may withdraw from the group at any time without any obligation.
Typed Signature of Participant: *
Date *
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Please feel free to contact me with any questions you may have. 

Balance Holistic Counselling: 639-538-0169

balanceholistic.sh@gmail.com


South Hill Medical Clinic: 306-556-1344

890 - A Lillooet St W

Moose Jaw Sk

S6H 8B4


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