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 profession?

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

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

* 4. Do you talk with your clients/patients and their family members about respite care when it is applicable?

* 5. Do your clients/patients and their family members request information, referral, or assistance on respite services?

* 6. Have you ever made a referral for respite services?