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Grief Assesment

Grief naturally occurs after a significant loss. Grief is a whole-being experience which commonly affects people physically, cognitively, emotionally, behaviourally, socially, and spiritually.

 

To be able to understand how you are experiencing grief, please complete the following self-assessment. The counsellor will use this information and what you share in conversation to develop a care plan.

What has prompted you to seek grief support at this time? (Select all that apply): I am…

What changes do you notice in your physical health?

Sleep patterns:

Thanks for submitting!

What has prompted you to seek grief support at this time? (Select all that apply): I am…

  • Having difficulty coping with my usual activities (errands, work, socializing, hobbies, exercise)

  • Feeling ‘stuck’ in my grief; things aren’t getting any better

  • Feeling alone/unsupported by my usual support network (family, friends, neighbours, etc.)

  • Needing to talk about my loved one; the circumstances of the death; and/or our relationship

  • Acting on encouragement from family/friends to get help/support

  • Other (please explain)

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