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Caregiver Support Survey

We are exploring the possibility of offering a caregiver support program in our community.

If you currently care for a family member or friend, we’d value your input. This survey is short and will help us design something that truly meets your needs.

Thank You!
1.Are you currently a caregiver?
2.Who do you primarily care for? (check all that apply)
3.What type of care do you provide? (check all that apply)
4.What are your biggest challenges as a caregiver? (choose up to 3)
5.Would you be interested in a caregiver support group?
6.What would you find most helpful? (check all that apply)
7.What days/times would work best for you? (check all that apply)
8.What format would you prefer?
9.What might make it difficult for you to attend? (check all that apply)
10.Would any of the following help you attend? (check all that apply)
11.Would you be interested in bringing your care receiver with you to a caregiver support group?
12.If yes, would you like something for your care receiver to do at the same time as the support group?
13.What topics would you like covered?
14.Any additional comments or suggestions?
15.If you’d like to be contacted about this program, please share your name, address and telephone number. (Optional)