2021 Spiritually Healing Through Grief - Registration Form

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* 1. Welcome. We will use the answers to this questionnaire to talk with you about your grief and the "Spiritually Healing Through Grief" workshop. First, tell me... what grief and/or loss are you currently dealing with? (such as loss of a loved one, loss of a job, loss of freedom, etc.)

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* 2. What are the top three (3) things (vision, goal, actions, feelings, etc.) that you wish to gain from this workshop?

1.

2.

3.

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* 3. What do you believe it is costing your life (e.g. time, money, sanity, relationships, etc) to not overcome your grief? What is going to happen if you are not able to overcome these challenges? Please be specific and focus on what matters to you.

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* 4. From this list, right now, how committed are you to overcoming your challenges and achieve your vision, desires and goals for your life?

The most important priority

A top priority, but not the most important

Not very important

Not important at all

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* 5. Do you have any specific questions, concerns or fears that I need to know about? If so, please describe (remember, this is just between us)? If not, please write in "NONE" in the text box.

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* 6. Please enter your contact information below

Full Name:

Email Address:

Phone Number:

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* 7. Thank you for your insights. I will reach out to set up a time for us to speak. Is there anything else you want me to know? If not, please write "COMPLETE" in the text box.