Individual Grief Client Outcome Questionnaire (3 Month Update)Please enable JavaScript in your browser to complete this form.Name *FirstLastDateAssigned TherapistZIP CodeGrief Symptom AssessmentPlease rate yourself in the following areas:Current level of emotional distress Selected Value: 0 0 = Low Stress ; 7 = High DistressCurrent level of spiritual distress Selected Value: 0 0 = Low Distress ; 7 = High DistressCurrent ability to cope with emotional stress Selected Value: 0 0 = Low Ability ; 7= High AbilityCurrent ability to cope with your everyday life Selected Value: 0 0 = Low Ability ; 7 = High AbilityUnderstanding of the grief process Selected Value: 0 0 = Low Understanding ; 7 = High UnderstandingUnderstanding of grief coping strategies Selected Value: 0 0 = Low Understanding ; 7 = High UnderstandingUnderstanding of stress mangement strategies Selected Value: 0 0 = Low Understanding ; 7 = High UnderstandingUnderstanding of community resources Selected Value: 0 0 = Low Understanding ; 7 = High UnderstandingGrief Counseling FeedbackHow strongly would you agree with the following statements about your assigned therapist?My therapist made me feel understood while attending the Individual Counseling sessions Selected Value: 0 0 = Strongly Disagree; 7 = Strongly AgreeMy therapist provided me a good understanding of the grief process and resources in my sessions Selected Value: 0 0 = Strongly Disagree; 7 = Strongly AgreeMy therapist was sensitive to my cultural background Selected Value: 0 0 = Strongly Disagree; 7 = Strongly AgreeMy therapist was sensitive to my spiritual background Selected Value: 0 0 = Strongly Disagree; 7 = Strongly AgreeMy therapist provided me with appropriate referrals and made me aware of FVHH support groups that fit my grief needs Selected Value: 0 0 = Strongly Disagree; 7 = Strongly AgreeI would recommend FVHH's Grief Counseling Services to others Selected Value: 0 0 = Strongly Disagree; 7 = Strongly AgreeIf FVHH could change anything that would help us better support grieving individuals what would it be?Submit