Bereavement Support Group Feedback

1. Details:

Name:
Session Number:

2. Were you pleased with the level of services you received at the session?

	Strongly agree	Somewhat agree	Neutral	Somewhat disagree	Strongly disagree
Feeling understood	Feeling understood Strongly agree	Feeling understood Somewhat agree	Feeling understood Neutral	Feeling understood Somewhat disagree	Feeling understood Strongly disagree
Feeling accepted	Feeling accepted Strongly agree	Feeling accepted Somewhat agree	Feeling accepted Neutral	Feeling accepted Somewhat disagree	Feeling accepted Strongly disagree
Feeling safe	Feeling safe Strongly agree	Feeling safe Somewhat agree	Feeling safe Neutral	Feeling safe Somewhat disagree	Feeling safe Strongly disagree
Given the opportunity to talk about what I wanted	Given the opportunity to talk about what I wanted Strongly agree	Given the opportunity to talk about what I wanted Somewhat agree	Given the opportunity to talk about what I wanted Neutral	Given the opportunity to talk about what I wanted Somewhat disagree	Given the opportunity to talk about what I wanted Strongly disagree
The group's approach is a good fit for me	The group's approach is a good fit for me Strongly agree	The group's approach is a good fit for me Somewhat agree	The group's approach is a good fit for me Neutral	The group's approach is a good fit for me Somewhat disagree	The group's approach is a good fit for me Strongly disagree
Feeling part of the group	Feeling part of the group Strongly agree	Feeling part of the group Somewhat agree	Feeling part of the group Neutral	Feeling part of the group Somewhat disagree	Feeling part of the group Strongly disagree
The session helped me with my concerns	The session helped me with my concerns Strongly agree	The session helped me with my concerns Somewhat agree	The session helped me with my concerns Neutral	The session helped me with my concerns Somewhat disagree	The session helped me with my concerns Strongly disagree
Positive changes have occurred to me as a result of a session	Positive changes have occurred to me as a result of a session Strongly agree	Positive changes have occurred to me as a result of a session Somewhat agree	Positive changes have occurred to me as a result of a session Neutral	Positive changes have occurred to me as a result of a session Somewhat disagree	Positive changes have occurred to me as a result of a session Strongly disagree

3. Were you pleased with the level of services you received?

4. Any other comments you would like to bring to the group's attention?