Fall 2023 Closed Group for Art Therapy

Your information

• *******This group runs IN-PERSON for 8 weeks on Wednesdays, Oct 18-Dec 06 from 6:30-8:30pm.*******

• * First Name:
• * Last Name:
• * Email Address:
• * Confirm Email Address:
• * Phone:
• * Address 1:
• * City:
• * Province:
• * ZIP Code:

About your person who died

• * What is their name?
• * What is their relation to you?

• * How old were they when they died?
• * When did they die?
• How did they die?

About you

• * What is your gender?
• * What is your age?
• * What is your primary language?
• *

  Do you have support from others?

  • Local family
  • Family out of town
  • Local friends
  • Friends out of town
  • Community organizations
  • Religious organization
  • Little to no support
  • Other
• * Do you have previous losses? (Who and when)
• * Do you have children, or pets? If yes, please list their name, age, where they live and how often you are in contact with them.
   characters remaining
• *

  Are you receiving counselling?

  • Family Doctor
  • Social Worker
  • Registered Therapist / Counsellor
  • Psychiatrist / Psychologist
  • Other
  • Not receiving any counselling
• *

  What is your employment status?

  • Working full-time
  • Working part-time
  • Not working (laid off, disability, etc.)
  • Retired
  • Student
  • Will return to work or school in next 1 to 3 months
  • On sick leave or leave of absence
  • Other
• * What are you struggling with in your grief?

About the support group

• *

  This group is In-person. Are you OK with attending in person?

  • Yes
  • No
  • Not sure
• *

  It is important for group cohesion to have continuity within the group. Are you able to commit to attending all 8 weeks?

  • Yes
  • No
  • Not sure
• *

  An intake interview is required before joining this group. When are you available? Check all that apply.

  • Weekdays 9am-noon
  • Weekdays noon-4pm
  • Weekdays 6-9pm
  • Sat 9am-4pm
  • Sun 9am-4pm
• *

  Important: Prior to attending this support group, participants need to have attended at least 2 BFO-Ottawa support groups.

  • I attended Thursday noon-1:30
  • I attended Tuesday 7-9pm (with speaker beforehand)
  • I attended Wednesday Walking Group noon-1:30
  • I attended a Closed Group in the past
  • I attended an Art Therapy group
  • I attended a grief group elsewhere
  • I will register to attend 2 groups
  • I cannot attend other groups
• * What are you looking forward to in this group?
• * What are your concerns / hesitancy about joining this group?
• *

  BFO-Ottawa relies on the generosity of donations in order to run our programs. We are sensitive to people’s financial situation because we know it can change with a significant loss. Are you able to make a suggested donation of $250 prior to the first meeting?

  • I can make a $250 suggested donation prior to the first meeting
  • I can donate $250 in installments
  • I can make a partial donation
  • I am not able to make a donation at this time
• * Please share any other information that you feel is important for BFO to know.
• * How did you hear about BFO-Ottawa and this support group?

• Thank you for taking the time to tell us about yourself. ***Sign up below to receive BFO's email updates. ********* IMPORTANT: If you've previously signed up, leave the box empty to ensure you don't receive an ERROR MESSAGE.