Where are you at in your Grief Journey? Self Assessment

1
Name* This field is required.So we can address you personally and respectfully in this assessment.
First Name
Last Name
2
Email
example@example.com
3
Have you experienced the loss of a loved one?* This field is required.This could be the passing of a family member, close friend, or someone who held a special place in your life. We ask this with care, simply to better understand your experiences and offer appropriate support if needed.
YESNO
4
What was your relationship to the loved one who passed away?* This field is required.Understanding your connection to the person you've lost helps us better support you in your grief journey. Please let us know who they were to you—such as a parent, spouse, child, sibling, friend, or other.
Spouse
Sibling (brother or sister)
Parent (mother or father)
Child
Aunt or Uncle
Friend
Coworker
Other
5
Has your loved one recently passed away, and while you were surrounded by family during the initial days, you're now feeling a sense of loneliness as they return to their own lives?* This field is required.It’s common to feel isolated or disconnected as the support from others fades. We want to acknowledge and support you through this challenging transition.
YES
NO
OTHER - I still want more information
6
Has it been a few years since your loss, yet you still feel the need for help or direction in your life?

You’ve already worked through some of the earlier stages of grief (1-3) and have identified what you need, but now you're ready to move forward with a renewed sense of purpose. Whether you're looking to supercharge your life or overcome inner turmoil, I'm here to guide you. Together, we can help you walk or run toward success in conquering your inner self and finding peace.
7
Do you feel stressed or overwhelmed by friends or family constantly asking how you're feeling, making it hard for you to spend time with them?* This field is required.On a scale of 1-10, how much does this impact your ability to connect with others and find peace in your own space?
8-10 EMERGENCY MODE
5-7 Remedial Mode
3-4 Self Help mode
1-2 Thrive Mode
8
Do you feel stressed about getting out of bed each day, struggling with the motivation to face the day ahead?* This field is required.On a scale of 1-10, how much does this lack of motivation affect your ability to move forward in your daily life?
8-10 EMERGENCY MODE
5-7 Remedial Mode
3-4 Self Help mode
1-2 Thrive Mode
9
Have you been eating more than usual, possibly binge eating, and found it difficult to stop?* This field is required.Have you noticed weight gain of 10 pounds or more as a result? This could be a sign of emotional stress or coping, and we're here to support you through this challenge.
10+ lbs
5-9 lbs
1-4 lbs
Doesn't Apply to My Situation
10
Are you struggling with not eating enough, feeling too thin, or lacking an appetite?* This field is required.This might include having little desire to eat, feeling disconnected from hunger cues, or finding it difficult to nourish your body properly. If you've been feeling like you're not getting enough food, it could be a sign of emotional or physical stress, and we’re here to help you navigate through it.
10+ lbs
5-9 lbs
1-4 lbs
Doesn't Apply to My Situation
11
Are you currently experiencing any health issues?* This field is required.This could include physical, emotional, or mental health challenges that are affecting your day-to-day life. Please select the option that best reflects your current situation.
Yes, I am dealing with multiple significant health issues that I haven't been able to address
Yes, I have a couple of health concerns that I am struggling to manage
Yes, I have minor health issues but am managing them with little difficulty
No, I am currently in good health and do not have any ongoing health concerns
12
Is your house or living space being neglected?* This field is required.This could refer to repairs, maintenance, or general upkeep that has been left unattended due to emotional or physical exhaustion. Please select the option that best reflects your current situation.
Yes, I have 5 or more repairs that I don't feel motivated to fix
Yes, I have 2 repairs that I don't feel motivated to address
Yes, I am maintaining my home, with just a few minor items left on my to-do list
No, I am able to maintain my household and pay my bills without issue
13
Are your bills piling up, and do you find it hard to get motivated to pay attention to them?* This field is required.This could involve feeling overwhelmed by financial responsibilities, leading to difficulties in staying on top of payments. Please select the option that best describes your situation.
Yes, my bills are piling up and I feel overwhelmed by them
Yes, I have some bills that I’m struggling to keep up with
Yes, I’m managing most of my bills, but some are occasionally delayed
No, I’m able to stay on top of my bills and manage my finances
14
You've taken an important step in recognizing how you're feeling and where you may need support.

It's not easy, but acknowledging these challenges is the first step toward positive change. Whether it's struggling with grief, health issues, house repairs, or staying on top of your bills, remember—you don't have to go through this alone.

Stop the pattern today by taking small, manageable steps forward. Think positive and know that each choice you make brings you closer to healing and clarity. Long-term help is available, and we’re here to guide and support you through this journey. You have the strength to move through this, and with the right support, you can reclaim your peace and balance.
15
Your ResultsBased on your responses, here's where you currently stand in your journey:
16
80-100: Emergency Mode
You are in urgent need of support. I invite you to schedule a One-on-One Coaching session so we can work together to address your most pressing concerns and get you back on track.

61-79: Remedial Mode
You’re dealing with significant challenges, but there's hope! I recommend our One-on-One Coaching to provide personalized guidance and help you get back on the path to healing and growth.

40-60: Self-Help Mode
You're making progress but may still need a little push. I invite you to join our Group Coaching sessions and the Hike Outdoor Retreat, where you can get the support you need while connecting with others who understand your journey.

20-39: On Your Way - Complete Mode
You’re moving in the right direction! I invite you to attend my LIVE LOVE SURVIVE THRIVE – Outdoor Retreat, where we’ll focus on healing, self-growth, and bringing you closer to the life you desire.

Less than 20: Thrive Mode
Congratulations! You’re in Thrive Mode! It's time to celebrate your progress and push forward. Let’s create new bucket list items together and keep the momentum going by attending my LIVE LOVE SURVIVE THRIVE – Outdoor Retreat.

You are not alone on this journey, and there’s always support to help you move to the next level. Let's take the next step together!
Should be Empty: