Print or export as you go. Your responses are saved on this device only. Clearing your browser data or switching devices will erase your work. Use the Download PDF or Print button above to keep a permanent copy. Download PDF creates a blank worksheet with its example, when available. Use Print Worksheet to keep your completed answers.

One Door a Day

One copy per invitation, or per decision not to ask. Write afterward. Record a refusal without guessing why.

Module 4

Example: Completed Example: One Door a Day

Fictional example. An adult daughter visits her father.

Date and occasion, or why I chose not to ask
Tuesday afternoon, after we watched part of a gardening show.
The one invitation I offered, if any
Can I ask you one thing about dying today? You can say no.
Their words, refusal, or no answer; mark any summary
He said, 'Not today. Tell me if you ever planted those bulbs.'
What I said or did after their response
I said, 'Not today, then.' I told him I had left the bulbs in the shed. We talked about that.
Their stated wish about stopping, quiet, or asking again
He declined today's conversation. He did not say if he wanted another invitation.
One choice consistent with that wish, or nothing further
I will leave the subject alone for this visit. I won't report to the family that he refuses to discuss dying.
© 2026 Linda A. Curran, BCPC, LPC, CAADC, CCDPD | Aware and Present