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Caregiver Survey
Caregiver Book Club Survey - 2023
Caregiver Support Group - Peer Matching Survey
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Indicates required field
What is your name?
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Who do you serve as a caregiver?
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Daughter
Son
Wife
Husband
Other
If Other please specify:
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How old is the person you serve as a caregiver?
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Less than 13
19-25
26-35
36-50
Over 50
Is your loved one currently an AHIF client?
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Yes
No
Not Sure
Please indicate the AHIF Support Specialist you have communicated with
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Marilyn Davis
Bethany Leonard
Aimee Lott
Pat Motley
Jenn O'Dell
Briana Reed
Cindy Woodcox
I don't remember the name
I have never worked with an AHIF Support Specialist
What is your age?
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19-25
26-35
36-50
Over 50
How long have you served in your role as caregiver?
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Less than 1 year
1-3 years
3-6 years
7-10 years
More than 10 years
Please select the two (2) traits you feel best describe you as a caregiver.
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Patient
Attentive
Dependable
Trustworthy
Compassionate
Please choose up to two traits you feel best describe you.
Please select the two options below that best describe your struggles/challenges as a caregiver.
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Exhausted
Impatient
Guilty
Uninformed
Isolated
Angry
Disorganized
If you would like to receive text reminders for meetings, please enter your cell phone number below.
*
If you would like to receive e-mail reminders, please enter your e-mail address below.
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Thank you for taking time to complete this survey. Click the "Submit" button below to submit your survey responses.
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