The Greater Mercy Foundation
Returning to our nature

Grief and Loss Questionnaire

Grief and Loss Questionnaire

What losses have you experienced?

Our curriculum helps grievers create a new level of awareness. Part of that process is helping you to better understand all of the different life experiences that produce grief. The questions below may increase your own awareness to issues of grief and loss in your life.

Nearly everyone who reviews this list of questions will be able to answer yes to at least one question. Loss is a normal part of living, and unresolved grief is painful. Unresolved grief is cumulative. 

This questionnaire is for you alone, a self-assessment, and it is up to you whether or not to share it.

  1. Did you move more than twice before the age of 10?
  2. Did you ever have a pet die?
  3. Did you have early childhood religious training?
  4. Have you experienced a major change in financial conditions, positive or negative?
  5. Have you ever quit a job?
  6. Have you ever been fired?
  7. Have you ever been married?
  8. Have you ever been divorced?
  9. Did you graduate from high school?
  10. Did you graduate from college?
  11. Have you ever experienced the death of a spouse?
  12. Have you ever experienced the death of a child?
  13. Have you experienced the death of a close family member?
  14. Have you experienced the death of a distant family member?
  15. Were you physically abused during childhood?
  16. Were you physically abused as an adult?
  17. Were you sexually abused during childhood?
  18. Were you sexually abused as an adult?
  19. Have you ever been involved with a miscarriage, stillbirth or abortion?
  20. Do you have a strained or painful relationship with a living parent(s), spouse, or friend in your work environment?
  21. Do you harbor any resentments or ill-feelings toward a deceased parent(s), spouse, friend, or relative?
  22. Have you ever experienced the loss of the use or function of any part of your body?
  23. Are there long stretches of your childhood that you cannot remember?
  24. Have you experienced a series of illnesses or accidents?
  25. Have you been involved in a long series of unsuccessful relationships?

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