The grieving process impacts all areas of a person's life. The symptoms are similar to the signs and symptoms of long-term stress. Which of the following symptoms did you notice in yourself at the time of your loss?
Loss Related Changes
Since your loss, have you noticed any changes related to:
NOTE: If client currently works with a therapist and/or psychiatrist, GrieveWell requires an “Authorization for Release of Information” to be signed and on file in our office.
Past / Current Legal Issues
GrieveWell respects the privacy of clients. Your personal information will only be accessible to GrieveWell staff and will not be shared or used for purposes outside of the GrieveWell Peer Counseling Program.
After completing this form you will be contacted by our Program Director within one week to review the information and discuss our services.