Evaluation of Capital Caring Health Grief Support Services

Your grief experience matters! Capital Caring Health aims to provide compassionate and personal grief support. We invite you to share to help us improve.

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* 1. Please check below ALL services you have received

NONE

Grief Education Group

Hospice Bereavement Mailings

Group Support: 4-8 Weeks

Group Support: Drop In/Ongoing Group

Group Support: Topic Focused Workshop

Individual Hospice Grief Counseling: In-Person

Individual Hospice Grief Counseling: ZOOM

Individual Hospice Grief Counseling: Phone

Ceremony of Remembrance

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* 2. Rate your experience

Very Helpful

Helpful

Not Helpful

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* 3. How long ago did the death of your loved one occur?

Less than 6 months

6-12 months

Over 12 months

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* 4. How long have you received grief support services?

1-3 months

4-6 months

6-12 months

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* 5. Were Capital Caring Health Grief Support Services compassionate and did they meet your standards?

Yes

Somewhat

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* 6. Were Capital Caring Health Grief Support Services sensitive to your cultural and spiritual needs?

Yes

Somewhat

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* 7. Would you recommend Capital Caring Health Grief Support Services to others?

Yes

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* 8. If your loved one received Capital Caring Health Hospice Services, how would you rate the bereavement mailings you received?

Very Helpful

Helpful

Not Helpful

Did not receive

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* 9. Help us help you. Tell us what worked and did not work in supporting you on your grief journey.

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* 10. If you would like follow up from the Grief Support Team, please provide your name, email address and/or phone number.

Name

Email Address

Phone Number