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Grief Group Therapy
We would love for your to share a little about yourself to ensure that this group is right for you! Your answers will be kept confidential.
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Email
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Your email
Phone
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Your answer
Name
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Your answer
Email
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Your answer
Please enter your date of birth
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MM
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DD
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YYYY
Why would you like to be in this group?
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Your answer
Is there anyone with who you would not want to be in a group with?
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Your answer
Do you have any prior experience with group work, counseling or other mental health services?
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Yes
No
Required
If yes, please elaborate.
Your answer
Are you currently participating in mental health therapy (i.e., group, individual, family, relational)?
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Yes
No
Required
If yes, please provide provider's name and office.
Your answer
What are you hoping to gain from this group?
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Your answer
Can you commit to this group for 6 weeks?
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Yes
No
On a scale from 1-5, how comfortable are you sharing personal information in front of others?
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Very Uncomfortable
1
2
3
4
5
Very Comfortable
Please include any additional information about yourself that you feel that the facilitators of the group should know about you.
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Your answer
What are your impressions of group counseling?
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Your answer
Thank you for your interest! You will receive a follow up email from one of the facilitators with additional information.
This group will meet every Monday 9am-10:30am via Zoom for six weeks beginning November 2nd.
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