Complete this survey and email Jeff at ed@familiesmattercoop.ca by Sunday, January 31, to be entered in a draw for a chance to win a $10 Bridgehead gift card.

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* 1. Who is completing this survey?

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* 2. What is the gender of your loved one with a developmental/intellectual disability?

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* 3. What age group is your loved one part of?

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* 4. Please describe your loved ones disability?

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* 5. How satisfied is your loved one with their interpersonal relationships?

  Not satisfied Somewhat satisfied Satisfied Very satisfied
Friendships?
Sexual relationships?
Romantic relationships?

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* 6. Is your loved one currently seeking new relationships?

  Yes No
Friendships?
Sexual relationships?
Romantic relationships?

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* 7. How easy is it for your loved one to engage in meaningful relationships without external support?

  Very difficult  Somewhat difficult Easy Very easy
Friendships?
Sexual relationships?
Romantic relationships?

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* 8. Does your loved one have the ability, knowledge, and skills to form healthy relationships?

  Very limited Limited Somewhat capable Fully capable
Friendships?
Sexual relationships?
Romantic relationships?

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* 9. Does your loved one have the ability to form meaningful interpersonal relationships with people outside of the family circle or developmental disability community?

  Very limited Limited Somewhat capable Fully capable
Friendships?
Sexual relationships?
Romantic relationships?

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* 10. What resources have your loved ones accessed to help build the skills, knowledge and confidence to engage in meaningful interpersonal relationships?

0 of 10 answered
 

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