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Caregiver Survey: How are You Doing?
Are you or someone you know a caregiver for someone in your family? Do you feel guilty because you can’t do enough, you haven’t enough.. [fill in the blank] to take care of everyone and everything because of your caregiving responsibilities? If the answer is ‘yes,’ then please read on and note if any of the following experiences are also true for you.

At the end, we will email you some feedback on how well you are managing the stress relative to other caregivers.

Email address *
1. Give the number of years you have been providing care for 1 or more people. *
2. Currently I rate my health as *
3. Since becoming a caregiver, my health has *
4. The number of caregiving hours that I provide weekly are *
5. The percent of caregiving that I personally provide to my loved one amounts to _%__ of their total care. *
6. I felt I had no choice in taking on caregiving responsibility for my loved one. *
7. I feel that caregiving responsibilities are fairly shared among family members. *
8. I neglect or put off my own medical care. *
9. My relationship with one or more family members is suffering. *
10. I'm not as good a spouse/partner as I used to be. *
11. On a scale of 1 - 5, how do you rate your stress level as a result of caregiving role. *
No Stress
Very High Stress
12. I’m not as good a parent as I used to be. *
13. Within the past 2-4 weeks, I have felt… (check all that apply) *
Required
14. “The reason I provide caregiving to _________ is because….. *
Your answer
15. Take Care of Me Means…” *
Your answer
Results
You may not yet have experienced all of these symptoms of caregiver stress. But if you answered ‘yes’ to 4 or more of the above questions, now is the time to focus on you. Taking care of yourself improves your ability to care for your loved one. Care-giving is a growing need in the US, with 4 in 10 adults are a caregiver to another family member. Moreover, this number will increase dramatically in the next 10-15 years. Those who ignore their own needs at the expense of caregiving have an increased chance of becoming a care receiver themselves. Look for more information about your responses in your email inbox.

To learn more about ways you can balance caregiving with self-care, call and request a free 15-minute consult at (972) 809-8272.

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