Caregivers & sleep
Exit this survey
1. Demographics - care giver
Please answer the following questions about you as the caregiver of a mentally ill person
*
1
. Your age in years
Your age in years
*
2
. Gender
Gender
Male
Female
*
3
. Marital Status (Please select one)
Marital Status (Please select one)
Married
Single
Divorced
Separated
Widowed
Living with a partner
*
4
. The mentally ill person is my (Please select one)
The mentally ill person is my (Please select one)
Spouse
Child
Parent
Grandparent
Grandchild
Friend
Other (please specify)
*
5
. In what part of the United States do you live? (Please select one)
In what part of the United States do you live? (Please select one)
Northeast
Mid Atlantic
Northwest
South
Midwest
*
6
. I live in same house as mentally ill person (Please select one)
I live in same house as mentally ill person (Please select one)
Full-time
Part-time
Not at all
If the mentally ill person does not live with you full-time, please estimate the number of miles that he/she lives from you.
Javascript is required for this site to function, please enable.