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Preparing for Your Healing Journey

Thank you for registering for the He Walks With Me Grief & Wellness Cohort.


Before we begin, we'd love to learn a little more about your journey so we can support you with care and intention.


Your responses are confidential and will only be viewed by Barbara and her designated support team.


This questionnaire should take approximately 10–15 minutes.


There are no right or wrong answers—please answer as honestly as you feel comfortable.

Your Information

Your Journey

How long has it been since your loss or major life transition?

Your Story

Emotional Wellbeing

Please select the option that best describes how you feel today.

I feel emotionally overwhelmed.
Never
Rarely
Sometimes
Often
Almost Always
I experience anxiety about my future.
Never
Rarely
Sometimes
Often
Almost Always
I feel emotionally supported.
Never
Rarely
Sometimes
Often
Almost Always
I have moments of peace.
Never
Rarely
Sometimes
Often
Almost Always
I can express my emotions in healthy ways.
Never
Rarely
Sometimes
Often
Almost Always
I feel hopeful about healing.
Never
Rarely
Sometimes
Often
Almost Always
I feel isolated from others.
Never
Rarely
Sometimes
Often
Almost Always

Spiritual Wellbeing

I feel connected to God.
Never
Rarely
Sometimes
Often
Almost Always
Prayer brings me comfort.
Never
Rarely
Sometimes
Often
Almost Always
I struggle with spiritual questions.
Never
Rarely
Sometimes
Often
Almost Always
My faith gives me hope.
Never
Rarely
Sometimes
Often
Almost Always
I feel spiritually supported.
Never
Rarely
Sometimes
Often
Almost Always

Daily Functioning & Wellness

I sleep well.
Never
Rarely
Sometimes
Often
Almost Always
I have enough energy to complete daily tasks.
Never
Rarely
Sometimes
Often
Almost Always
I am taking care of my physical health.
Never
Rarely
Sometimes
Often
Almost Always
I can focus throughout the day.
Never
Rarely
Sometimes
Often
Almost Always
I feel motivated.
Never
Rarely
Sometimes
Often
Almost Always
I am maintaining healthy relationships.
Never
Rarely
Sometimes
Often
Almost Always

Reflection

Confidentiality Agreement

He Walks With Me Grief & Wellness is committed to creating a safe, sacred space where clients can share openly without fear. Confidentiality is a foundational part of the support we provide. By participating in this cohort, I agree not to share any information about other participants at any time.  If I share information, I understand that I will be removed from the cohort and I will not receive a refund for the remainder of the cohort

Contact

Please complete the contact for all

speaking inquiries.

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© 2026 Barb Felder.

Thanks for submitting! We'll be in contact within 48 hours.

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