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* 1. Who is the provider of your caregiver services?

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* 2. What is your county of residence?

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* 3. Age

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* 4. Gender

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* 5. Race

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* 6. Household composition. Do you live... Check all that apply

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* 7. How did you learn about our services?

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* 8. What caregiver services did you receive? Check all that apply.

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* 9. Are you better able to care for your loved one and yourself as a result of the service(s) you have received from the Family Caregiver program?

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* 10. If you participated in a training program, did you experience any of the following? Check all that apply.

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* 11. If you participated in counseling or a support group, did you experience any of the following?

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* 12. Have your needs been met through the caregiver services you received?

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* 13. Do you feel you had timely access to obtaining information when calling this program?

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* 14. Overall, are you satisfied with the services provided by this program?

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* 15. Are there additional services (other than those received) that would be helpful to you as a caregiver?

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* 16. Suggestions for improving caregiver services:

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