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Grief Counseling Intake Form

Welcome those seeking grief support with a gentle intake form capturing their situation, the support they need, and contact details.

Description

The Grief Counseling Intake Form gives your practice a gentle, respectful way to welcome people reaching out for support. It captures their name and contact details, whether they have experienced a recent loss, and who they lost, so your counselors understand each person’s situation before the first conversation.

A field for the kind of support they are looking for, with space to specify, helps you match each person to the right service, whether that is one-to-one counseling, a group, or practical guidance. An open note invites anything else they wish to share, on their own terms.

Handling intake with care and consistency helps people feel heard from the very first step. Sign up for a free Fun Forms account to customize the fields and embed this intake form on your website.

Form fields

Everything the Grief Counseling Intake Form above collects — 8 fields, so you can see exactly what it captures before you make it your own.

Counseling Intake

  • What's your name?

    Name Icon
    Name

  • Email address

    Email Icon
    Email

  • Phone Number

    Telephone Icon
    Telephone

  • Have you experienced a loss recently?

    Single-Select Icon
    Single-Select

  • Who did you lose?

    Short Answer Icon
    Short Answer

  • What kind of support are you looking for?

    Multi-Select Icon
    Multi-Select

  • Please specify:

    Short Answer Icon
    Short Answer

  • Anything you'd like us to know?

    Long Answer Icon
    Long Answer
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Template FAQs

Common questions about the Grief Counseling Intake Form — what it captures, when to use it, and how to make it your own.

What is a grief counseling intake form?

A grief counseling intake form is an online form that gently gathers information from someone seeking bereavement support. It captures their contact details, whether they have experienced a recent loss, and the kind of help they are looking for, so counselors can offer the right support with care.

How does it help match support?

By asking what kind of support someone is looking for, with a space to specify, the form helps you direct each person to the most suitable service. Whether they need individual counseling, a support group, or practical guidance, you can respond appropriately rather than offering a one-size-fits-all reply.

Is the form gentle for grieving people?

Yes. The form uses open, optional fields and simple language so people can share only what they feel comfortable with. It avoids intrusive questions, invites them to add anything they wish, and lets them reach out at their own pace, which matters greatly when someone is dealing with loss.

Can people describe their situation freely?

Yes. An open note field lets people share anything they would like you to know in their own words, rather than fitting their experience into fixed options. This gives your counselors valuable context and helps each person feel genuinely heard from the moment they first make contact with your practice.

How does this help counselors prepare?

Because each intake arrives with the person’s situation and needs already captured, counselors can prepare thoughtfully before the first session. Understanding who someone lost and what support they want means the initial conversation can focus on the person rather than on gathering basic details, making support feel more personal.

Is the grief counseling intake form free?

Yes, this grief counseling intake form is completely free, and you can customize the fields to suit your practice, embed it on your website, and go live with no coding required. Just create a free Fun Forms account to start supporting people with care online.

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