PARTNERS Support Group & Healing Circle: Registration / Intake Form: Grief Circles -

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Thank you for joining Grief Circles online gatherings and support group for partners, widows, widowers and spouses, and for providing your information.

To join this heartful and tender space of grief, we start here, by getting to know you a little bit. We trust that we can ask for your participation in keeping this space safe. The information you provide is kept confidential.

If you are registering someone else, as gift or otherwise, please provide their information, and only yours where specified (Your name and email address.)

You will receive instructions before we begin our first session. If you have any questions, please feel free to reach out to info@GriefCircles.com and also mark this email address as safe, so emails go in your Inbox automatically.

After you complete the form, pease continue with payment to complete your registration.

Wishing you ease and peace,
Yasemin Isler, Center for MCCG

Full Name *

Email *

Please share your partner's age and year of death, if you wish, their name and the nature of their death. *

Your relationship to the person who died: *

Please tell about your intention, goals and hopes for joining: *

How did you hear of us? Please mention your group affiliation, if any: *

Will you be able to join all (or most) meetings? *

Are you currently in therapy for your grief? For how long? *

Location (City, State, County) and Time Zone: *

Profession *

Age *

Please share if you have a preferred pronoun:

Your Full Name, IF you are registering for someone else, or giving this as a gift.

Your Email, IF you are registering for someone else, or giving this as a gift.

If you are giving this as a gift, after what date do you want them contacted? (this date needs to be prior to the start of the course)

YYYY

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