| If 6 months or more have passed since the death of.............., please answer the following questions: |
| BRIEF GRIEF QUESTIONNAIRE |
NOT AT ALL |
SOMEWHAT |
A LOT |
| How much of the Tone are you having trouble accepting the death of a loved one? |
0 |
1 |
2 |
| How much does your grief still interfere with your life? |
0 |
1 |
2 |
| How much are you having images or thoughts of your loved one when she died or other thoughts about the death that really bottler you? |
0 |
1 |
2 |
| Are there things you used to do when your loved one was alive that you don't feel comfortable doing anymore, that you avoid? Like going somewhere you went with him/her, or doing things you used to enjoy together? |
0 |
1 |
2 |
| Or avoiding locking at pictures or talking about your loved one? How much are you avoiding these things? |
0 |
1 |
2 |
| How much are you feeling cut off or distant from other people since your loved one died, even people you used to be close to the family or friend? |
0 |
1 |
2 |
