Forever Footprints Intake Form

We are so sorry for your loss. We want you to know that the Forever Footprints Family is here for you. You will receive a phone call with more information and to answer any questions.

Thank you for taking the time to provide the below information. Once this form is filled out, please feel free to register for any and all of our groups. You can find our support group registration link on our website and Instagram bio.

Name

Phone Number

Yes, it's okay to send me text messages including confirmations, changes, and updates. Message frequency varies. Message and data rates may apply. View our terms of service & privacy policy.

Address

Which county do you live in?

Birthday

Gender

Male
Female
Other
Prefer not to answer

Please tell us more about your loss so that we can best support your needs.

How many losses have you experienced?

List the name of your doctor, doula or midwife

List the hospital you delivered at (if applicable)

Tell us why you wish to attend a support group

Please check the box if an additional person will attend group with you

Spouse or Partner
Friend
Relative
Other

Is there anything else you would like us to know?

Are you interested in scheduling a one-on-one Zoom appointment to talk with our Director of Support Programs? If you select yes, our Director of Support will schedule a Zoom appointment with you when we contact you.

Group Registration

After you've completed this intake form, you will have the option to register for the support options we have available. Registration is required for all groups, and you will register for each group you attend on an ongoing basis.

Please note that the registration form link will remain the same each month. As the month's groups conclude, the registration form will be updated with the dates and times for the following month's groups. An email is sent when the next month's dates have been updated. Upon registration for a group, you will receive a confirmation email with the pertinent details. You will also receive a confirmation text closer to the date of the group(s). You are welcome to register for more than one group each month.

We encourage early registration to secure your spot as some of our groups are capped at a specific number of participants. Finally, due to the sensitive nature of these groups, please do not bring children/babies with you to our in-person or virtual groups.

Group Types

We have two types of groups available at this time. Open groups are provided on an ongoing basis, and registration for those groups is available on an ongoing basis. Closed, loss-specific groups are groups that run for a pre-determined period of time (usually 8-10 weeks). These groups have a registration period, and once the registration window has closed, we cannot accept new participants.

*Please note that each closed, loss-specific group has its own, separate registration form since they are all different and have varying start and end dates. Emails will be sent out before the registration window opens with all the details. You must register by the deadline in order to participate in closed group.

*Please also note that Peer Groups are not facilitated by licensed therapists and are not meant to serve as therapy. Peer groups help our families find support, comfort, and community.

Calendar of Events

You can find the Calendar of Events at this link: https://www.foreverfootprints.org/calendar-of-events/

We know this is a lot of information, so please don't hesitate to reach out to [email protected] with any questions! A staff member will also be reaching out to you within 1-2 business days to discuss any questions you may have.

Participation Policies

I have read and agree to the terms above.

Our support groups are funded by donations. A donation of any amount is greatly appreciated to ensure we can continue running our support groups. Would you like to make a donation?

Almost done. Where should we send the confirmation?

Name

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