Caregiver Feedback  
(5 mins)

If you care for a LifeStriders participant with a disability (including physical, mental, emotional, cognitive, behavioral, or developmental disability, a chronic health condition or psychiatric condition, or blindness or deafness or others), please complete the following questions. This information will remain confidential and can be submitted anonymously.
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Email *
Your (Caregiver) Name: *
Participant Name: *
Before coming to LifeStriders, how difficult did it seem to find and obtain needed services for your child or family member? (i.e. appropriate resources and or therapeutic interventions, groups or programming for the person with a disability) *
Not Difficult
Extremely Difficult
How difficult would it have been for you to be able to pay for full cost therapy services such as PT,OT, SLP, Counseling or Groups or specialized programming? *
Not Difficult
Extremely Difficult
Prior to coming to LifeStriders, how difficult was it for you, as the primary caregiver, to focus on your own health and wellness? *
Not Difficult
Extremely Difficult
Did LifeStriders provide access to therapies, support services or programming for your family member with a disability? *
Comments - Access (optional)
Since participating at LifeStriders, do you feel more supported and less stressed? *
Comments - Stress (optional)
Do you feel that your (caregiver) health and wellness has been positively affected by having your family participate at LifeStriders? *
Comments - Well being (optional)
Since participating at LifeStriders, do feel that you are better able to cope with the disability of the participant? *
Comments - Coping (optional)
Since participating at LifeStriders, have you received helpful information, resources, training (workshops, consultations with staff) to support you in the long-term care of the participant with a disability? *
Comments - Resources (optional)
What positive outcomes have you noticed for yourself since participating at LifeStriders? *
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This form was created inside of LifeStriders Therapeutic Center.