How often do you reflect on past losses? *

Rarely

Occasionally

Frequently

Almost Constantly

Which best describes your current coping mechanisms? *

I rely on support from friends and family

I engage in hobbies or distractions

I keep my feelings to myself

I’m unsure how to cope

Are you open to seeking guidance to navigate your grief journey? *

Yes, I believe professional help could be beneficial

Maybe, but I’m uncertain where to start

I prefer to handle it on my own

I’m not sure if I need guidance

Do you find it difficult to talk about your loss with others? *

No, I can discuss it openly

Sometimes, depending on the situation

Yes, I find it very challenging

I avoid talking about it altogether

How has your daily routine been affected since your loss? *

I've maintained my usual routine.

I struggle with some daily activities.

Many aspects of my routine have changed.

I find it challenging to carry out most daily tasks.

Do you find yourself avoiding places or activities that remind you of your loved one? *

No, I continue to engage in them.

Occasionally, but not often.

Yes, I avoid them frequently.

I completely avoid any reminders.

How would you rate your current support system? *

Excellent; I have strong support.

Adequate; support is available when needed.

Limited; I have minimal support.

I feel isolated without support.

Full Name *

Email *

Phone *

NEXT