Sister Support Questionnaire
All information shared is confidential
Full Name
First Name
Last Name
E-mail Address
example@example.com
Contact Number
Is this your first time being apart of a support group?
Yes
No
On a scale of 1-10 (10 being very challenging and 1 being very manageable) how do you feel on average about your loss or traumatic experience?
0-3 (manageable with few episodes)
4-6 (I have more days of feeling overwhelmed than not)
7-10 ( I’m activated most days and it’s hard to focus on daily tasks without struggle)
Would you be comfortable sharing with our sister circle? (Everything shared is confidential)
Yes
No
Briefly tell us what is challenging for you to work through?
What do you need the most help with?
Accountability
Coping Skills
Resources
How do you prefer to be contacted?
Call
Text
Email
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