Opioid Loss Homicide Support Group

Navigating Grief After Opioid Loss

An Online Support Group for Loved Ones of Opioid Victims
Registration Form - Tuesday, September 26th | 6:30 - 8:00 pm

(Registration is required for each meeting)
First Name*
Last Name*
Phone Number

Area CodePhone Number
Email*
example@example.com
Do you need an interpreter for this meeting? There is no fee for this service. NCVAN requires 5 days of notice to provide this service. If yes, please list the language required.
Language
Optional Information: Please only fill out once. If you have attended prior meetings, we only need the info once.
Name of your loved one.
My loved one is/was my __________ (son, daughter, friend, parent, brother, sister, etc.).
Please check all that apply to the opioid death of your loved one:
When did the homicide occur?
Where did the homicide occur?
Where do you reside (County, town, state)?
What else do you want us to know about you, your loved one, or what happened?
Would a different day and/or time of day for a support group work better for you or someone you know? If so, please list a few options.
How did you learn about our support group?

NewspaperOnline adWebsiteLaw enforcement or prosecutorTherapist or clergyFriend or family memberTV adOther
Do you have any upcoming court dates? If so, when and where?
Should be Empty:

Navigating Grief After Opioid Loss