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Navigating Grief & Loss Support Group Screen
Please complete the screening questions below.  Marj (group facilitator) will review your responses and contact you within a few days.  Your information is confidential and will not be shared.  
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Email *
First and Last Name  *
Phone Number *
Please tell me about the person in your life who died.  What was your relation to them, how old were they, etc. *
How long ago was their death? *
What do you hope to get out of attending this support group? *
Have you attended any other groups, or sought therapy/counseling? *
How did you find out about this group? *
Anything else you would like me to know?
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