Please enable JavaScript in your browser to complete this form.Name *FirstLastZIP Code:Support Group Name:Group FacilitatorsDate of Last SessionPlease rate your current level of DistressLevel of Emotional Distress Selected Value: 0 1 = Low Ability 10 = High AbilityLevel of Spiritual Distress Selected Value: 0 1 = Low Ability 10 = High AbilityPlease rate your current ability to:Cope with your emotional distress Selected Value: 0 1 = Low Ability 10 = High AbilityFunction in your every day life Selected Value: 0 1 = Low Ability 10 = High AbilityPlease rate your current knowledge of the following:Your knowledge of the grief process Selected Value: 0 1 = No Knowledge 10 = A Lot of KnowledgeYour knowledge of grief coping strategies Selected Value: 0 1 = No Knowledge 10 = A Lot of KnowledgeYour knowledge of stress management strategies Selected Value: 0 1 = No Knowledge 10 = A Lot of KnowledgeYour knowledge of community resources Selected Value: 0 1 = No Knowledge 10 = A Lot of KnowledgeGroup FeedbackHow strongly would you agree with the following statements about your group and your facilitator(s)?The facilitator made me feel welcome while attending the support group meetings Selected Value: 0 0= Strongly Disagree 7= Strongly AgreeThe facilitator encouraged discussion from all group members Selected Value: 0 0= Strongly Disagree 7= Strongly AgreeThe facilitator was flexible in adjusting to the groups needs Selected Value: 0 0= Strongly Disagree 7= Strongly AgreeThe facilitator provided an environment that felt safe to express myself within the group Selected Value: 0 0= Strongly Disagree 7= Strongly AgreeI would recommend this FVHH support group to others needing grief support Selected Value: 0 0= Strongly Disagree 7= Strongly AgreeHow did you hear about the group?What did you find MOST helpful about the group?What did you find LEAST helpful about the group?How can we improve this group for the future?MessageSubmit