Virtual Family Support Group Interest Form Survey

Legacy Lifecare (Chelsea Jewish Lifecare & JGS Lifecare) recognizes the pain and agony our families are feeling during this COVID-19 pandemic and is offering a virtual family support group to our residents’ loved ones.

In this two session group series, participants will have an opportunity to share their thoughts and feelings in a supportive and safe space while connecting with other families who truly empathize. During each session, helpful coping strategies and other resources will be shared by our experienced social workers.

To inquire about the group or express interest in joining, please fill out this form and a facilitator will contact you directly.

1.Contact information(Required.)

Name

Email Address

Phone Number

2.Resident name

4.Resident location

6.What is your primary interest in joining a family support group? Please check all that apply.

Reduce feelings of loneliness and isolation

Reduce anxiety and stress about your loved one

Opportunity to openly share your emotions with others

Gather information and learn coping skills

Meet and be with others who share similar experiences

Other (please specify)

8.What questions do you have about the Virtual Family Support Group?