Caregiving.com: Family Caregivers Focus Group 33% of survey complete. Question Title * 1. Please provide your contact information. We'll email you about an opportunities to participate in market research. You can always decline opportunities. And, you can opt out at any time. Contact Denise at denise@caregiving.com if you have questions. Name: ZIP: Country: Email Address: Phone Number: Question Title * 2. How old are you? Between 21 and 35. Between 35 and 50. Between 50 and 60. Between 60 and 70. Between 70 and 80. More than 80 years old. Question Title * 3. Your gender: Male Female Question Title * 4. Are you married? Yes. No. Question Title * 5. Do you have children still living at home? Yes (please include ages in the box below) No Question Title * 6. If yes, please indicate the ages of your children. 5 years of age and under. Between 6 and 10 years of age. Between 10 and 13 years of age. Between 14 and 18 years of age. Between 18 and 22 years of age. Older than 23. Question Title * 7. For how many family members or friends are you caring? One Two More than two Question Title * 8. If you care for more than one, are you caring for a married couple? Yes No Question Title * 9. How old is your caree (the person receiving your care)? Under 30. Between 30 and 45. Between 45 and 60. Between 60 and 70. Between 70 and 80. Between 80 and 90. More than 90 years old. Question Title * 10. Please select your caree's gender. Male Female Male Female Male Female Male Female Question Title * 11. Indicate your caree's primary diagnosis: Alzheimer's disease Parkinson's disease Arthritis Diabetes Heart Disease Stroke Dementia Cancer Lung Disease Fraility MS ALS Other (please specify) Question Title * 12. How long have you been a family caregiver? Less than six months Six months to one year One to two years Two to five years Five to nine years More than ten years Next >>