Application for 3-Day Healing Loss Workshop

 

All personal information entered on this application form will be kept confidential and will only be reviewed by the staff and facilitators of the Healing Loss workshop. This information is important to ensure safety and to help us be aware of any issues that might be important for you as a workshop participant. This information will not be available to anyone else within or outside of Montefiore. Please feel free to contact Peter Selwyn at (718) 920-8434 or pselwyn@montefiore.org with any questions or concerns.

 

Note: If you prefer to handwrite, paper applications can be downloaded at www.montefiore.org/healingloss

The online application consists of approximately 30 items contained in 5 pages. Pages 2-3 include questions of a personal nature (e.g., your experiences of loss; health/medical history). Please allow yourself adequate time - and privacy, if needed - to complete this form.