Caregiver Saathi - A survey of caregivers

There are many ways in which a caregiver is challenged and often the caregiver also needs care, emotional support, understanding, easy access to information, guidance from experts and wisdom from others who have similar experiences. It is our endeavour to bring it all together and make it easy access for the caregiver.

We are trying to understand the needs of the caregivers through this survey. We appreciate your time and request you to share the survey with others who you think can participate

Email address *
Captionless Image
Your address *
Mobile no. *
Are you a caregiver yourself? *
How long have you been a caregiver? *
What is the medical condition of the loved one you care for? *
Please describe the specific details about the disease *
Your relationship with the patient? The patient is your.... *
Which doctor do you consult?
What would you like support in? *
What do you think of this initiative? *
How would you like to participate/ contribute to this initiative? *
Comments - please share any additional comments and thoughts you may have
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy