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FIVCO FAMILY CAREGIVER SUPPORT PROGRAM SATISFACTION SURVEY
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Do you or the person you are providing care for receive the following services?
In-home Respite Services
Adult Day Care Respite
Information
Assistance with Access to Services
Caregiver Counseling
Caregiver Training or Education
Caregiver Support Groups
Other
How would you rate that service?
Excellent
Good
Fair
Poor
In-home respite services
Adult Day Care Respite
Information
Assistance With Access to Services
Caregiver Counselling
Caregiver Training Education
Caregiver Support Groups
Other
Excellent
Good
Fair
Poor
In-home respite services
Adult Day Care Respite
Information
Assistance With Access to Services
Caregiver Counselling
Caregiver Training Education
Caregiver Support Groups
Other
How would you rate the quality of FIVCO Caregivers Support Program?
Very Dissatisfied
1
2
3
4
5
Very Satisfied
Clear selection
Overall, how satisfied are you with the services provided to you by the FIVCO Caregiver Support Program?
Very Dissatisfied
1
2
3
4
5
Very Satisfied
Clear selection
Before using the FIVCO Caregiver Support Program, how well do you feel that you would have met the needs of the person you are caring for?
Not at All
Somewhat
Well
Very Well
Clear selection
To what extent do the services that you receive through FIVCO Caregiver Support Program help you to be a better caregiver?
They help a lot
They help a little
They don't help
They make things worse
Clear selection
Have the services provided through FIVCO Caregiver Support Program enabled you to provide care for your loved one longer?
Yes, Definitely
Yes, I think so
No, I don't think so
No, Definitely not
Clear selection
Because of my participation in the FIVCO Caregiver Support Program, I am more aware of community services that can help me as a caregiver
Not at all
Somewhat
Well
Very well
Clear selection
How would you rate the response of the Family Caregiver Coordinator in addressing your needs as a caregiver?
Poor
1
2
3
4
5
Excellent
Clear selection
How would you rate the information provided to you by the FIVCO Caregiver Support Program?
Poor
1
2
3
4
5
Excellent
Clear selection
Have the services provided helped to decrease your stress level as a caregiver?
Yes, definitely
Yes, I think so
No, I don't think so
No, definitely not
Clear selection
Do you have any additional comments or concerns that you would like to be addressed?
Your answer
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