Share Your Sibling Loss Story Share Your Sibling Loss Story The Broken Pack is a newly formed organization created to support survivors of adult sibling loss. In order to best serve you, we want to hear your story and needs. Who was (were) your sibling(s) that died? * Your brother Your sister Your non-binary sibling Your stepsister Your stepbrother What date did your sibling die? (if more than one sibling, please indicate the one for which you would like to share information today.) * How old was your sibling when they died? * How old were you when your sibling died? * How would you describe the relationship you had with your sibling? * Do you have other siblings? * Yes No How many other siblings do you have? Please tell us the story of your loss. * I felt supported by friends and family in the immediate days and week following my sibling's death. (1= Strongly Disagree, 2=Disagree, 3= Neutral, 4=Agree, 5=Strongly Agree) * 1 2 3 4 5 I currently feel supported by friends and family regarding my grief and my sibling's death. (1= Strongly Disagree, 2=Disagree, 3= Neutral, 4=Agree, 5=Strongly Agree) * 1 2 3 4 5 What or from whom would you like more support from (e.g. mental health professionals, friends, family, books, blogs, online/ in-person support groups)? Are there other things you would like us to know? * Yes No What else would you like us to know? Would you like to be contacted or kept up-to-date on The Broken Pack's future endeavors, supports, news, etc? Don't worry, we will not spam you. * Yes No Would you be willing to be contacted to share your story further (potentially in a podcast, in an interview, for a book, on a website, etc.)? * Yes No Name Name First First Last Last Phone Email What is your gender? * Male Female Non-Binary Other What is your gender? reCAPTCHA Submit Start Over
