Please read every question carefully.

*A Lifespan Respite of Washington (LRW) grant from the federal Administration for Community Living will help us develop a small pilot respite services for individuals with a TBI and their family/friend caregiver in the next year.

* 1. What is your connection to brain injury? Choose all that apply:

* 2. How long has it been since the brain injury occurred?

* 3. What age category best fits the individual receiving care?

* 4. What types of respite care do you think are available in your area? Choose all that apply:

* 5. If you have received information about respite care services in the past, where did you get the information? Choose all that apply:

* 6. When was the last time you, as the person with a brain injury, or caregiver participated in some kind of respite care activity?