Support Services & Resources Questionnaire
Please complete this form so that we can find the right resources and support services for you.
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Thank you for reaching out to The Grief Hub. We're so sorry for the loss that has brought you here. 

This form helps us understand your situation so we can connect you with the most relevant resources, support options, and information. 


1. Contact Information
Name  *
Email *
Phone number 
Preferred method of contact *
Column 1
Email
Phone
Text Message
Zoom or Google Meets
No preference
2. About Your Loss
What type of loss are you grieving? 
How long ago did your loss occur? 
Would you like to briefly describe your loss? 
3. Current Support
Do you have support from any of the following? 
Column 1
Family
Friends
Therapist/Counselor
Faith Community
Coach or Mentor
Online Community
No current support
Your state/country (only necessary if you're looking for in-person services or online counseling from a therapist, as some can only provide services within their state)
5. Resources You're Looking For
Column 1
Grief education and information
Licensed Therapist or Counselor
Local support group (in-person)
Online support groups
Books and reading recommendations
Podcasts
Resources for families
Resources for kids/young adults
Workplace grief support
Community connections
Other
6. Additional Information
Is there anything else you would like us to know about your situation or needs? 
7. Consent
Column 1
I understand that The Grief Hub provides resources, education, and support connections and is not a crisis service or emergency mental health provider.
I consent to being contacted regarding resources and support options.
I would like to receive emails about grief resources, events, and programs
Crisis Notice
If you are experiencing thoughts of harming yourself or are in immediate emotional distress, please contact emergency services or a crisis hotline in your area immediately. 
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Thank you for trusting The Grief Hub. We are honored to support you on your grief journey. 
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