Get Grief Consultation Intake Form_dsa

The Grief Consultation Intake Form_DSA is designed to gather essential information to support individuals navigating their grief journey. This guide will provide step-by-step instructions to complete the form online, ensuring you feel comfortable and informed throughout the process.

Follow the steps to fill out the Grief Consultation Intake Form_DSA online.

1. Click the ‘Get Form’ button to retrieve the Grief Consultation Intake Form_DSA and open it for editing.
2. Begin by filling in your name in the designated field. Provide your age and select your sex from the options given.
3. Enter the current date in the appropriate section.
4. Fill in your complete address, including street name, city, state, and zip code.
5. Provide your home and cell phone numbers, ensuring to mark the best number to contact you.
6. Input your email address, which will be used for communication.
7. Indicate whether you are currently working with a therapist or medical professional regarding your grief. If yes, mention how long you have been receiving their support.
8. If you are taking any medications, list them in the corresponding field, along with the name and phone number of the professional assisting you.
9. Answer whether you grant permission for your situation to be discussed with that professional.
10. List the names of your deceased child or loved ones, along with their birth dates and death dates. Include their age at the time of death.
11. Specify your relationship to the deceased, selecting from the provided options, or add an alternative relationship.
12. Mention any surviving children or loved ones in your family and their ages.
13. Reflect on your past losses and list them, stating your age when each loss occurred.
14. Describe what you learned from your family about coping with loss and grief during your upbringing.
15. Outline the present circumstances for which you are seeking support, specifically involving the illness or death of a loved one.
16. Detail any difficulties you are currently facing in physical, emotional, cognitive, behavioral, and spiritual aspects.
17. Indicate if you have a support system in place for your grief, such as family or friends.
18. Assess whether you feel stuck in your grief and elaborate on why you feel this way.
19. Explain how religious or spiritual beliefs influence your grief journey.
20. List any other stressors you are experiencing in addition to your grief.
21. Describe any strategies you have employed to cope with your grief, as well as their effectiveness.
22. Articulate your hopes and goals for entering into this consulting relationship.
23. Once completed, save the form as a PDF. You can either email the PDF to the specified address, print it and fax it, or bring it to your appointment. If you cannot email or print, arrive early to complete the form in person.

Complete your Grief Consultation Intake Form_DSA online today to take the first step in your healing journey.