Good Grief Group Assessment
First Love Yourself Counseling Support Soiree Assessment
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
What is your current age?
*
Date of Birth
*
-
Month
-
Day
Year
What gender do you identify with?
*
Please type in: Male, Female, etc
"Good Grief" Group Assessment Questions
Please rate your experience in each of these areas:
I think it would be helpful to share my thoughts and opinions with others
Not At All
1
2
3
4
Very Much
5
1 is Not At All, 5 is Very Much
How often are you impacted by your loss?
Almost never
Daily
Weekly
Once a month or less
Who or what are you grieving?
Please briefly share
Do you have any active suicidal or homicidal thoughts?
*
Yes
No
Beliefs About Grief
Please rate your experience in each of these beliefs:
1. My heart will always have this wound.
Not At All
1
2
3
4
Very Much
5
1 is Not At All, 5 is Very Much
2. My grief and mourning should be focused on my departed. Self-care is selfish.
Not At All
1
2
3
4
Very Much
5
1 is Not At All, 5 is Very Much
3. I must do grief alone because no one can possibly understand the pain I am going through.
Not At All
1
2
3
4
Very Much
5
1 is Not At All, 5 is Very Much
4. I will never be happy again.
Not At All
1
2
3
4
Very Much
5
1 is Not At All, 5 is Very Much
5. Even seeing a grief therapist is not going to help me feel better.
Not At All
1
2
3
4
Very Much
5
1 is Not At All, 5 is Very Much
6. My departed is gone. If I stop longing for them, I may forget him/her.
Not At All
1
2
3
4
Very Much
5
1 is Not At All, 5 is Very Much
7. If I move forward, that is dishonoring my departed.
Not At All
1
2
3
4
Very Much
5
1 is Not At All, 5 is Very Much
8. Loss is a part of life. Grief is a natural consequence of loss.
Not At All
1
2
3
4
Very Much
5
1 is Not At All, 5 is Very Much
Submit
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