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Parenting Stress
Demographic Information
1.
What is your gender?
Female
Male
Other
2.
What is your age?
15-24
25-34
35-44
45-54
3.
What is your marital status?
Single
Married
Separated or Divorced
In a relationship but not married
Other (please specify)
4.
Do you have support in parenting?
Yes, my partner and I co-operate and work as a team
I have paid assistance (nanny, babysitter,etc)
I have a lot of help from my mother and/or other family members
I feel supported by my friends
I feel very much responsible for the parenting decisions
I am truly a single parent and do it all on my own
I consult professionals often (GP, Psychologist, Child Health Nurse, Lactation consultant, etc)
Other (please specify)
5.
If you are separated/divorced, do you still co-parent the children?
Yes - shared arrangements
We co-operate and make decisions together
I am the primary caregiver and the other parent has access
I have access only
No contact with the child/ren
Not applicable
6.
If there are two adults in the home, are they both the biological parents of all children in the home?
My partner and I are the biological parents of all children in our home.
My partner and I have adopted our children.
My partner and I are part of a blended family (containing children from prior relationships).
Other (please specify)
7.
Do you work outside the home?
Fulltime
More than three days per week
Half-time or less
No
8.
What is your family's annual income?
$0-40,000
$40,000-65,000
$65,000-95,000
$95,000-130,000
$130,000-160,000
$160,000+
9.
How many children do you have?
1
2
3
4+
