This free survey is powered by QUESTIONPRO.COM
0%
Exit Survey »
 
 
What kind of grief/loss have you experienced?
 
Death of someone (children, parent, sibling, spouse, friend, pet, etc…)
 
Loss of professional status/role (retirement, lay off or resignation)
 
Disease/disability of a family member (Alzheimer, traumatic accident, etc)
 
Loss or change of family dynamic/relationship (due to infidelity or divorce)
 
Disease or disability; grieving the “healthy” you (cancer, AIDS, accidents, etc)
 
Loss of house/property through catastrophic events or foreclosure;
 
Going through a traumatizing event like rape, assault, war, etc
 
 
 
How long ago did it happen?
   
 
 
 
What kind of coping strategies have you used to help you through the process? (ex: physical exercises, outing with friends, support group, etc…)
   
 
 
 
At what stage(s) of your grieving process do you think you needed to find ways to relieve emotional distress?
 
Denial and isolation
 
Anger
 
Bargaining (need to regain control, protection from the painful reality)
 
Depression
 
Acceptance
 
 
 
Have you ever use any kind of art expression to help you cope during grieving/loss?
 
YES
 
NO
 
 
 
Would you be interested in participating in a visual art project to help you cope with negative feelings related to a loss you have experienced?
 
YES
 
NO
 
 
 
If you are interested, please contact me at: [email protected] or give me your information and I will update you on the upcoming sessions.
 
Survey Software Powered by QuestionPro Survey Software