About Us
Careers
Newsroom
Contact Us
REGISTER
PA
WV
UNDERSTANDING DONATION
Donation Process
Dispelling the Myths
Donation for Research
Living Donation
Donor Families
Donor Family Support
Navigating Your Grief
CORE Remembrance Quilt
A Special Place Ceremony
Brian A. Broznick Bereavement Center & Garden
Recipients
The Waiting List
Writing to Donor Families
Team Alleghenies Transplant
Recipient Resources
Community
Stories of Heroes
Show Your Support
Community Education
Request Educational Support
Download Brochures
Partners
Volunteer
Volunteer Application
Calendar of Events
Resource Request Forms
Professionals
Clinical Researchers
Donor Referrals
Eye Bank
Hospital Resources
Medical Examiners & Coroners
Funeral Directors
PA Organ and Tissue Donation Counseling Survey
What prevented you from utilizing grief counseling services through the PA Organ and Tissue Donation Counseling Program? (Check all that apply)
(Required)
I didn’t think any of the counselors were a good fit for me
The counselor I was referred to did not have times/dates that worked for my schedule
I did not hear back from the counselors with availability
I decided to wait to begin counseling
I received grief counseling elsewhere
Unsure
Other - please comment:
Other reason
Is there anything you would like to share with Gift of Life/CORE/Department of Health about your experience with the Grief Counseling Program?
Would you like someone from Gift of Life/CORE/Department of Health to follow up with you with additional counselor referrals or information regarding your loved one’s donation?
(Required)
Yes
No
Name
First
Last
Phone
Email
Phone
This field is for validation purposes and should be left unchanged.