Oasis for Caregivers:                                         Caregivers Needs and Survey
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.

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Email *
Your Full Name (as per NRIC) *
Your Mobile Contact Number *
Your Age
Your Gender *
A. I am a caregiver for: *
Required
B. What type of caregiver am I? *
C. Please choose which statement describes how you are coping as a caregiver *
D. Please choose which statement describes how you are feeling overall *
E1. What are some of your needs? *
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
No
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. *
Required
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