Trauma and Grief Writing: Own Your Story Questionnaire 
Thank you for being willing to fill out this form. Your answers will in no way disqualify you from participating in the group. 

I know what it’s like to have written and read and shared and cried, by myself and with others in a small group. And I know what the days after can feel like. 

Powerful emotions can bubble up during the writing and sharing times, but often they overflow after the writing has been done. 

My job is to make sure you feel safe and supported when writing and sharing your work, as well as afterward. I don’t want to leave you hangin’. 

Your answers are confidential and for the purposes of ensuring that you have the support that you need in the coming months.

Thank you!
Name *
Email Address *
Phone Number *

Have you participated in a group like this before? Any small group therapy or coaching? What were those experiences like for you?

Are you currently working with a therapist, coach, or mental health professional?

How do you practice regulating your nervous system and emotions?

Do you have 2 to 3 safe, supportive people that you can call on if needed after these writing experiences?
Do you have any questions about the group or the policies and procedures?
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