Do I Need Grief Counselling? Self-check from Sana Psychological.

1

Since experiencing a loss, have you felt extremely impacted or debilitated?* This field is required.

YESNO

2

Since experiencing a loss, have you had changes to your eating, hygiene and/or sleeping habits that are not shifting back to normal?* This field is required.

YESNO

3

Have you been sad, down, blue and/or numb the majority of the time and this is not changing over time or is getting worse?* This field is required.

YESNO

4

Since experiencing a loss, have you had thoughts or plans of hurting yourself?* This field is required.

YESNO

5

Have you experienced a recent loss or are anticipating a loss?* This field is required.

YESNO

6

Are you interested in learning more about healthy tools and coping?* This field is required.

YESNO

7

Since experiencing a loss, have you felt your feelings were out of control and felt unmangeable?* This field is required.

YESNO

8

Are you turning to substances and/or problem behaviours to help you cope with your feelings?* This field is required.

YESNO

9

Are your feelings getting more painful and uncomfortable as time is going on?* This field is required.

YESNO

10

Do you feel stuck in your grief process?* This field is required.

YESNO

11

Is this loss bringing up feelings about other losses you have experienced?* This field is required.

YESNO

12

Are you having trouble in relationships, work, personal coping, and/or other parts of life?* This field is required.

YESNO

13

Do you feel your mental health has declined due to grief and loss?* This field is required.

YESNO

14

What is your email? We'll send you more info.* This field is required.This is not a substitute for assessment and diagnosis. You may receive recommendations & free resources from Sana Psyc; you are free to unsubscribe at any time.

example@example.com

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Calculation

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Sorry :( This form is only availble in Canada

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