Memory & Movement Charlotte - Take Charge! Caregiver Survey
A generous grant from the Philip Van Every Foundation has provided us an exciting opportunity to expand Take Charge - an individualized and comprehensive education and support program to empower family and friends who walk alongside our Memory & Movement Charlotte patients. As we build this program, we are asking you, the family and friends of the care recipient, for critical insights by completing this short 5 minute survey.

*The term "care recipient" refers to the person who is a patient at MMC.

*"Care partner" is interchangeable with "caregiver", the support system for the care recipient.

*Answers will be anonymous.

*All program team members have signed a confidentiality agreement in compliance with HIPAA.

Thank you in advance for completing this survey and sharing your care partner experience with us!
What is your role with the care recipient?
Clear selection
What is your relationship to the care recipient?
Clear selection
How far does the care recipient live from you?
Clear selection
Are you set up with MMC to use the patient portal, the electronic messaging system?
Clear selection
From the following list, select ALL the diagnoses that have been given to the care recipient:
From the list below, select ALL answers that accurately complete this sentence: "I have a good understanding of..."
From the list below, select ALL the resources you have used:
From the list below, select ALL offerings of interest:
From the list below, select ALL format(s) for receiving care partner education that you prefer:
From the list below, select ALL preferred methods for MMC to relay information about caregiver education opportunities or activities in the community:
Please share any thoughts you have about what would make you feel more empowered as a caregiver:
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