Caregiver Survey

Winnipesaukee Public Health Council Caregiver Survey

The Winnipesaukee Public Health Council represents a wide variety of agencies in your community. The Council is gathering information on caregivers so that we may support you in your time of need. For more information on caregiver services & supports in our community please call 603-528-6945 at ServiceLink, 67 Water Street, Suite 105, Laconia, NH 03246.

Question Title

* 1. Do you feel you have sufficient caregiving skills you need to provide care?

Yes

Question Title

* 2. Are you receiving enough emotional support?

Yes

Question Title

* 3. Are you receiving enough financial support

Yes

Question Title

* 4. What other form of support do you need?

Question Title

* 5. Would you be interested in attending a Free Powerful Tools for Caregivers Training?

Yes

If you would like more information on Caregiver support services please fill in your contact information below and someone will contact you. If you would prefer you can contact ServiceLink Resource Center at 603-528-6945 at 67 Water Street, Suite 105, Laconia, NH. For more information email Marian Gill, ServiceLink Director at mgill@servicelinkpphnh.org.

Question Title

* 6. Yes, I would like more information about available Caregiver supports.

Name

Company

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

Thank you for participating in the Winnipesaukee Public Health Council's Caregiver Survey. If you have any further questions or comments regarding this survey please contact Marian Gill at mgill@servicelinkpphnh.org. The Health Council truly appreciates your time in providing valuable feedback.