Self Assessment Questionnaire
Hello and Welcome.  

We are so glad that you've decided to take the Self Assessment Questionnaire.  This questionnaire will help you identify the ways grief is impacting you right now and possible next steps.  Please don't overthink it, just check the ones that feel right for you.  We honour your privacy, we do not sell or share anyone's information - ever!

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Email *
Maria's Message
Name *
First Name and Last Name
Phone Number
Time Zone *
How long ago was your most recent loss: *
What was your relationship with the person who died? : *
What was the nature of the most recent death
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Have you suffered more than one loss in the last ten years?   *
What was your relationship with those who have died?  (Please fill in all relationships): *
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