1. Name

2. Telephone Number

3. Email Address

4. What is the name of the deceased?

5. What is your relationship to him / her?

6. What was your relationship like with this person?

7. Can you tell me a story that best describes him / her as a person?

8. Can you tell me a story that will endear this person to me?

9. Did you suspect this person was going to take their life?

10. How were you notified of their passing?

11. Was there any kind of grief counseling available to you?

12.. At any point did you deny that this could not have happened?

13.. Did you become angry with the person or those that informed you of the loss?

14.. Where there and did you blame external factors for their decision to take their life?

15. Did you at any point begin to bargain to bring the person back?

16. Was there a period of depression following the loss of this person.

17.. How long did this depressed state last?

18. How did you move beyond that depression?

19. At what point had you come to terms with the loss of this person?

20.. After all that you had been through, how freeing was it when you came to terms with their passing?

21.. How freeing was that moment?

22. Throughout the grieving process, what was the most difficult time for you?

23.. What kind of support did you get from family and friends?

24..Did you attend any support groups?

25.. Where you ever able to share your feelings and emotions with anyone?

26. What role did your faith play during the grieving process?

27. Do you ever wonder about the person’s eternal fate?

28.. Was the church available to you?

29.. If someone came to you because their loved one had just taken their life, what is some of the advice you would give them.

30.. What would you say to those thinking about suicide?

31.. May we contact you?

Yes
No

32.. Would you be able to tell your story on camera

Yes
No
Not Sure