1. We're grateful you'll be joining us!

We'd love to know more about your current situation.

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* 1. Address

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* 2. For whom do you care? (Please check all that apply.)

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* 3. Have you had any training on how to care for a family member? (Please check all that apply.)

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* 4. I understand my caregiving emotions are normal.

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* 5. I feel empowered to continue in my caregiving role.

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* 6. I feel connected to answers about my caregiving questions.

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* 7. I can begin to plan for my future.

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* 8. I can begin to prepare for what may come next during my caregiving experience.

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* 9. I can implement coping strategies during times of stress.

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* 10. I feel comfortable providing care to my family member.

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* 11. I feel comfortable managing changes in my family member’s care needs.

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* 12. I feel comfortable asking for what I need.

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* 13. I feel supported.

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* 14. Please share any information you’d like us to know about your caregiving situation.

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