Intake Form

Intake Form

All new attendees must first fill out our intake form below. You will then be contacted to complete an intake phone call.

Our support groups are open to those in New York City and Long Island.

If you have any questions about our groups or other programs or need support finding other bereavement resources, please get in touch with COPE at (516) 832-2673 or

Formulario de admisión ›

"*" indicates required fields

Note: All in person and virtual groups are limited to those in the New York City/Long Island area. Please contact us as we might be able to provide recommendations of organizations outside of our area.

Loved Ones Name*
MM slash DD slash YYYY
MM slash DD slash YYYY

If we do not offer the type of group you are looking for, we will do our best to recommend another organization.

In order to maintain group numbers that will allow for the best opportunity for participants to connect and share, we cannot guarantee available space in every group at all times, but we will work with you to find the best fit for your needs.

Our Support Group Days: Are there any evenings you are NOT available (check all that apply)...

Where have you found support since your loss? (Check all that apply)