The Greater Mercy Foundation
Returning to our nature

Questionnaire for Children/Youth

Grief and Loss Questionnaire for Children

What losses have you experienced?

  • Did you move from one community to another one or more times?
  • Did you ever have a pet die or run away?
  • Are your parents divorced or living in different homes?
  • Have either of your parents re-married?
  • Do you live with someone other than your mom or dad?
  • Have you experienced the death of a close family member or friend?
  • Have you ever been bullied?
  • Have you been to more than one school?
  • Have you ever experienced the loss of function of a part of your body?
  • Have you ever experienced a series of illnesses or accidents?
  • Have you ever had a hard time making or keeping friends?
  • Have one of your family members ever had a long illness or injury?
  • Have you ever lost a really special toy, blanket, or special object?