Intake Form for bereavement support

Lazarus Hospiz Berlin

Intake form

To offer you the best possible support, we need to get to know you and your situation.
Please complete the short questionnaire as best you can, and one of our volunteers will follow up with you soon. You may skip any of the more personal questions you’re not comfortable answering.
(* mandatory)

What’s your name?

Your email address?

Your phone number?

What is your preferred method of contact (email, text, telephone, Whatsapp, Signal etc.)?

What times are you available to be contacted by a grief-volunteer?

Where are you from?

How long have you been in Berlin?

What languages do you speak fluently?

What is your living situation (alone or with roommates, a partner, family, etc.)?

Do you have local support here in Berlin? If so, please describe.

Are you currently seeing a therapist?

Please tell us whom you are grieving, and when, where and how they died. Feel free to include any information that you feel is relevant.

Are you interested in joining our grief group or are you looking for one-on-one support?

Last question, we promise :). How did you hear about us?

If you have any questions or concerns please feel free to contact us directly at:
goodgriefgroup@lobetal.de