Oasis for Caregivers: Caregivers Needs and Survey

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Many caregivers face challenges and deserve emotional support. We hope that you would fill out this survey so we can find out your needs and interests so we can better provide relevant assistance.

Email *

Your Full Name (as per NRIC) *

Your Mobile Contact Number *

Your Age

Your Gender *

Male

Female

A. I am a caregiver for: *

1. An Elderly Person(s)

2. A Person with Chronic Illness

3. A Person with Special Needs

4. A Person with Physical Disability

5. A Person with Mental Disability

Required

B. What type of caregiver am I? *

1. A Family Member who is working

2. A Family Member who is not working

3. A Domestic Helper

4. A Non-Family Member / Neighbour

5. A Volunteer

6. A Future Caregiver

7. A Part-time Caregiver

C. Please choose which statement describes how you are coping as a caregiver *

1. I am having a tough time coping

2. I am having some difficulty coping

3. I am coping ok

4. I am coping better

5. I am coping very well

6. Currently I have no problem coping because i haven't started yet

D. Please choose which statement describes how you are feeling overall *

1. I am very overwhelmed / stressed

2. I am quite overwhelmed / stressed

3. I am a little burdened

4. I am feeling ok

5. I am happy

E1. What are some of your needs? *

1. Information on Caregiver resources

2. Self-care/Wellness talks

3. Skills training

4. Regular Support group session

5. Encouragement

6. Counselling

7. Someone to share your burdens with

8. 1-2 hours of Respite (a short break)

9. None

Other:

Required

F. HOPEwwS would like to provide the following to support you as a caregiver: (tick all that you are interested in participating)

Tick if interested in particating

1. Information on Resources for caregivers

2. a 1 hour Self-Care/Wellness Talk (virtual)

3. a 1 hour Self-Care/Wellness (face-to-face), if feasible

4. a 1 hour monthly Support Group (virtual)

5. a 1 hour monthly Support Group (face-to-face), if feasible

6. Receiving encouragement via whatsapp, cards, etc

F1. When is the best timing for the Self-Care/Wellness talks or support group? (NOTE: if using your mobile, please view in landscape to see all the options)

Sat 10-11am

Sat 130-230pm

Sat 3-4pm

Weeknite 8-9pm

Other

None

1st choice

2nd choice

3rd choice

4th choice

5th choice

6th choice

Clear selection

G. Have you been vaccinated yet? (in preparation for face-to-face option, when feasible) *

Yes

Completed 2nd vaccine shot

HOPE worldwide Singapore is committed to handling your personal data with care and privacy under the Personal Data Protection Act (PDPA). I consent to the management of my personal data as stated in the Privacy Notice published on HOPE worldwide Singapore website. I also consent to the use of photos, interviews and recordings taken during events that I have attended for publicity purposes. *

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