Connect the DOTS Caregiver Survey

Thank you for taking a few moments to complete this survey.  It will help the community-wide Connect the DOTS team determine what kinds of support are most needed with those who provide care for our families and friends.  We appreciate your taking about 5 minutes to provide this input; please do so by Friday 17 September.  Thank you again!
1.For how many people do you currently provide care?
2.For whom do you currently provide care? (check all that apply)?
3.How often do you provide care?
4.Does the person for whom you provide care live in the same home with you?
5.Why are you providing this care? (check all that apply)
6.Were you providing this care before the COVID-19/coronavirus pandemic?
7.Do you have the ability to get away from caregiving when needed, such as for grocery shopping or just when you would like to have a break?
8.How long have you been providing care?
9.How long do you think you will continue to provide care?
10.What challenges do you have in providing care? (check all that apply)
11.How concerned are you as of today about the impact of the COVID-19/coronavirus pandemic on your ability to provide care?
12.Do you work outside the home?
13.Would you be interested in being part of a group of caregivers who would provide support for each other and share information about available resources for caregivers?
14.Would you be able to attend in-person meetings of such a group?
15.Would you be able to attend online meetings (Zoom or similar) of such a group?
16.(If yes to both #14 and #15) Which type of meeting would you prefer?
17.(If yes to both #14 and #15) What days/times would work best for you?
18.(If no to both #14 and #15) Would you still be interested in being informed of caregiver group activities, including info about available caregiver resources?
19.How many people live in your household, not including any person(s) for whom you are a caregiver?
20.Do you have any person(s) over age 65 living with you, not including any person(s) for whom you are a caregiver?
21.Do you have any person(s) under age 5 living with you, not including any person(s) for whom you are a caregiver?
22.Do you have any person(s) age 6-18 living with you, not including any person(s) for whom you are a caregiver?
23.What is your zip code?
24.If you would like to be included in future communications about caregiver resources, including a caregiver support group, please provide your name and an email address and/or phone number; this information will not be used for any other purpose.
Current Progress,
0 of 24 answered