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Caregiver 2023 Survey
Thank you for helping us understand your needs.
Livewell Pathway Foundation
1.
Who do you provide care for? ( check all that apply)
Baby - <3 years old
Young Kids 3-13 years old
Young Adults - >13 years old
Disabled Person
Accident Victim
Elderly Family Member
Terminally/ Chronically ill person
Power of Authority - Heath or Finance
Pets or Animals
I am a medical professional - PSW, Doctor, Nurse
None of the above
Other (please specify)
2.
What are some of the things that you need support with?
3.
How would you prefer to receive support as a caregiver? (Events, Online articles, one on one discussion/ consultation, group discussion)
4.
What topic areas do you need and want more information on?
5.
Have you been to a Caregiver support group?
Yes
No
6.
Have you been to a Livewell Pathway Foundation Caregiver group session?
Yes
No
7.
What City do you live in?
8.
Would you like to be contacted
Yes
No
9.
Please provide your information below........
Name
Company
City/Town
Email Address
Phone Number
200%