Please enable JavaScript in your browser to complete this form.Name *FirstLastZip Code *Date / Time *DateTimeAssigned therapist *Jacquelyn JenningsErik MeeksThird ChoiceSelect how much you agree/disagree with each statement.1=Strongly disagree 2=Disagree 3=Neutral 4=Agree 5=Strongly agreeI know about the different feelings of grief. Selected Value: 0 I have talked about the person who died. Selected Value: 0 I understand that everybody grieves differently. Selected Value: 0 I express my feelings to others. Selected Value: 0 I can name coping skills that work for me. Selected Value: 0 I am hopeful for the future. Selected Value: 0 My therapist helped me feel understood. Selected Value: 0 I am glad I came to grief counseling. Selected Value: 0 Submit