Disclaimer: We will not sell, rent, or share your information with third parties, individuals, or organizations. We will only use your information to guide our initiative and provide information about Healthier Boynton Beach's caregiving resources, events, and services.

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* 1. Do you ever provide care for someone who sometimes needs help taking care of him or herself?

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* 2. Do you consider yourself a caregiver?

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* 3. We understand that the caregiver and the person being cared for may live in different places.  Please tell us the zip code where the person being cared for lives if applicable.

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* 4. We understand that the caregiver and the person being cared for may live in different places.  Please tell us the zip code where you, the caregiver,  live.

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* 5. For whom do you provide care? SELECT ALL THAT APPLY

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* 6. How often do you provide care?

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* 7. How old are the individuals that require special medical care as the result of a medical health condition or from frailty from aging? SELECT ALL THAT APPLY

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* 8. Do you get help with your caregiving responsibilities?

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* 9. Do you need help (or more help) with your caregiving responsibilities?

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