Grief Experience Assessment

First Name

Last Name

Email *

Phone *

Briefly describe your experience with guilt and anger related to your loss:

How would you rate your ability to manage overwhelming thoughts and feelings?

I can actually cope fairly well right now, but it wasn't always that way.

I have so many intrusive thoughts interrupting my day, but I can recover within 30 minutes or so.

Intrusive thoughts about the loss completely debilitate me throughout the day and I can't control those thoughts or manage them. I'm overwhelmed

In your own words, what does hope for your recovery look like to you personally? What would you need to experience to feel that you have found recovery?

Are you confident that you can actually recover from grief?

No, I feel trapped here and don't see a way out.

I do, but I have no idea how to get there

Yes, and I'm ready for that to happen in my life

Do you have more good days or bad days? (Explain)

What tools/processes do you currently have for handling ambushes of grief and trauma loops?

Even though what happened was bad, there can be some positive outcomes. Are you seeing any positive outcomes from this mourning process? (Please explain your answer)

Answer with the option that is most TRUE for you!

I am sick and tired of being sick and tired and I am READY FOR HEALING!!

I have confidence and strength, and I'm willing to do whatever it takes to recover from this loss!

I agree to terms and conditions provided by this company. By providing my email and phone number, I agree to receive text messages from them about my assessment, as well as marketing messages.