Caregiver Insight Communication Survey Form
Share your experiences with communication and coordination. Your insights help us improve our caregiver support.
Your role as a caregiver
*
Please Select
Family member
Professional caregiver
Volunteer
Friend or neighbor
Other
How often do you communicate with your care team?
*
Daily
Several times a week
Once a week
Less than once a week
Preferred method of communication
*
Phone call
Text message
Email
Video call
In-person
Other
How clear is the information you receive from your care team?
*
Not clear at all
1
2
3
4
Extremely clear
5
1 is Not clear at all, 5 is Extremely clear
How responsive is your care team to your questions or concerns?
*
Not responsive
1
2
3
4
Very responsive
5
1 is Not responsive, 5 is Very responsive
How well does your care team coordinate with each other?
*
Poorly coordinated
1
2
3
4
Very well coordinated
5
1 is Poorly coordinated, 5 is Very well coordinated
How comfortable do you feel reaching out to your care team?
*
Not comfortable
1
2
3
4
Very comfortable
5
1 is Not comfortable, 5 is Very comfortable
How satisfied are you with the overall communication process?
*
1
2
3
4
5
What is one thing that works well in your communication with the care team?
What is one thing that could be improved in the communication or coordination process?
Submit
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