Dr. Rachel Natvig Counseling Psychologist

About
Compassionate Grief Support
Retreat
Resources
Connect

About
Compassionate Grief Support
Retreat
Resources
Connect

registration

To attend the grief retreat, please complete this registration form.

After receiving your form, you will receive an email with payment instructions.

Full Name

Phone

Room Preference (not guaranteed)

Private room Shared room No preference

Dietary Needs

No special dietary needs Vegetarian Vegan Gluten-free Dairy-free Nut allergy No eggs

Additional Dietary Notes

Your Grief Experience

Therapy Experience

I'm working with a therapist now I have worked with a therapist before Neither

Do you have other support available?

Yes No

Suicidal/Homicidal/Self-Harm History

Currently experiencing any suicidal, homicidal, or self-harm thoughts, plans, or actions I have experience such thoughts in the past I have engaged in suicidal, homicidal, or self-harm behaviors or gestures

How recently?

Are you currently taking any prescription medication for mental health conditions?

Yes No

Medication Details

Emergency Contact Name

Emergency Contact Phone

Relation to you

Anything else?

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for upcoming community gatherings, grief circles, wellness offerings and more!

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The Grief Midwife
Rachel Natvig, PhD, licensed counseling psychologist

Based in the Greater Burlington, Vermont area
In-person and online services available

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The content and services offered through this website are intended for educational, supportive, and personal growth purposes. Unless otherwise specified in a formal treatment agreement, participation in retreats, workshops, grief circles, or other offerings does not constitute psychotherapy or establish a psychologist-client relationship. If you are experiencing a mental health crisis or require clinical care, please seek support from a licensed healthcare provider or emergency services.

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