Caregiver Wellbeing Index Survey
Please complete this survey to help us understand and support the wellbeing of caregivers.
Your Full Name
*
First Name
Last Name
How would you rate your overall stress level as a caregiver over the past month?
*
Very Low
1
2
3
4
5
6
7
8
9
Very High
10
1 is Very Low, 10 is Very High
In the past month, how often have you felt emotionally overwhelmed?
*
Never
Rarely
Sometimes
Often
Always
How would you rate your physical health at this time?
*
Excellent
Good
Fair
Poor
Do you have access to support from family, friends, or community resources?
*
Yes, always
Sometimes
Rarely
No
How often do you engage in self-care activities (e.g., hobbies, exercise, relaxation)?
*
Daily
A few times a week
Once a week
Rarely
Never
Please share any additional comments or suggestions about your experience as a caregiver.
Submit Survey
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