Apply to Attend a Grief Support Group Seeking Grief Support Group Your Personal InformationName(Required) First Last Email Address(Required) Enter Email Confirm Email Phone(Required)Best Time To Call YouWhen is the best time for us to reach you via telephone?MorningsEarly AfternoonLate AfternoonBest Day To Call YouWhen is the day for us to reach you via telephone?MondayTuesdayWednesdayThursdayFridayLoss + Grief InformationAre you experiencing grief following the death of a loved one? Yes No Who have you lost? Partner Child Parent Friend When did the loss occur? (approximate date or timeframe): In the last 6 months In the last Year Over a Year Ago 2+ years 5+ years If you feel comfortable, please share a few words about how you’re feeling at this point in your grief journey. You might write something like, “It’s been a few months and I’m finding it hard to cope,” or “I’ve been feeling a bit lost lately.” Sharing this helps us better understand how to support you through the group process.If you feel comfortable, please share a few words about how you’re feeling at this point in your grief journey. You might write something like, “It’s been a few months and I’m finding it hard to cope,” or “I’ve been feeling a bit lost lately.” Sharing this helps us better understand how to support you through the group process.How did you find us? Google Social Media ie Facebook/Instagram GP or related Service Radio Word of Mouth Other Terms and Conditions(Required)By submitting this form, you acknowledge and agree that you are providing consent for NALAG Grief Support to contact you using the information provided. This may include communication via phone, email, or other means, as relevant to your inquiry. I agree to the terms and conditions.CAPTCHA
