Initial Screening Survey — Kira Elder Care

Request edit access

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

I'm researching the experience of coordinating care for an aging parent. If you or someone you know is in this situation, I'd love 3 minutes of your time. Completely anonymous. No selling, ever. Takes 3–4 minutes.

What is your age range? *

Under 30

30–39

40–49

50–59

60+

Where are you based? *

British Columbia, Canada

Ontario, Canada

Other Canada

United States

Other

Which best describes your caregiving role? *

I am the primary coordinator of care for an aging parent or family member

I share coordination equally with a sibling or partner

I help occasionally but someone else manages it

I am not currently a caregiver but have been in the past

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Forms