Supporting Families Grieving a Substance-Related Death
Thank you for requesting access to this webinar. We hope that the information it contains is helpful and meaningful for you and your family. At the Dr. Jay Children’s Grief Centre, we want to understand our clients’ concerns and needs as best we can, so that our services can be as effective as possible.

This short survey will help us learn a little bit more about the individuals who are accessing our resources and understand how comfortable and/or confident you feel talking with your children about substance use and substance-related grief, as well as your current understanding of children's grief and bereavement. We will ask the same questions after you have completed the webinar to see if any of the content altered your feelings and perceptions.

Completing this survey is voluntary, not required. You can skip any questions you'd like by indicating "Not Applicable" or "I prefer not to answer". We are not asking for your name so that your answers can be anonymous, however, we are asking for you to create a "code name" so we can determine how your responses may have changed before and after the webinar.

If you have any questions or concerns about this survey, please email
Please enter your code name: Initial of your LAST name, Initial of your FIRST name, Birth Year (i.e. Victoria Pileggi, 1989 = PV89) *
Your answer
How old is your child? (If you have multiple children, list all ages) *
Your answer
What is your relationship to the child? *
What is the child's relationship to the person who has died? The person was their... *
What other Dr. Jay programs or services have you attended/used? Check all that apply:
Has your family received support from any other agencies? If so, please indicate below:
Your answer
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy