The Grief Recovery Method® Questionnaire

This questionnaire is 100% CONFIDENTIAL and is designed to help you identify the different types of grief that you may be experiencing in order to decide if The Grief Recovery Method® is right for you. 

1. Did you move more than twice before the age of 10?
2. Did you ever have a pet die?
3. Did you experience an early childhood trauma?
4. Have you experienced a major change in financial conditions? (Positive or Negative)
5. Have you ever quit a job? Have you ever been fired?
6. Have you ever been married or divorced?
7. Did you graduate from high school?...from college?
8. Have you experienced the death of a distant family member?
9. Have you experienced the death of a close family member?
10. Were you physically abused during childhood? ...as an adult?
11. Were you sexually abused during childhood? ...as an adult?
12. Have you ever been involved with a miscarriage, stillbirth, or abortion?
13. Do you have a strained or painful relationship with a living parent(s), spouse, relative or friend?
14. Do you harbor any resentments or ill-feelings toward a deceased parent(s), spouse, friend, or relative?
15. Have you ever experienced the loss of the use or function of any part of your body?
16. Have you ever experienced the death of a spouse?
17. Are there long stretches of your childhood that you cannot remember?
18. Have you experienced a series of illnesses or accidents?
19. Have you been involved in a long series of unsuccessful relationships?
Name *
Name
Phone *
Phone

These questions are only a partial list of the possible LOSSES that we can experience.  If you answered YES to ANY of the above questions, there is a strong possibility that you have been given MISINFORMATION about how to deal the the pain caused by a loss. 

You may have been led to believe that:

  • You have to bury sad feelings.

  • Time heals all wounds.

  • You need to be strong for others.

  • You have to keep busy.

GRIEF is the NORMAL and NATURAL reaction to loss or change.  The clichés listed above and the hundreds of others not listed may have caused you to question your normal and natural responses.  Unresolved loss continues to build causing you to live in an emotional state all of the time.  Consequently, you may have spent, and continue to spend, an inordinate amount of time and energy covering up the painful feelings associated with loss. 

WELL LETS CHANGE THAT, SHALL WE?

The Grief Recovery Method® offers you the unique ability to transform the quality of your life so that you will be able to complete your relationship to the pain of your significant loss.