Feedback Form

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Do you feel more socially supported?

1. No, I feel very isolated
2. Not most of the time
3. Somewhat, but not all the time
4. Yes, usually
5. Yes, very much

Are you engaging more in community activities?

1. None at this moment in time
2. Very rarely
3. Occasionally/intermittently
4. Yes, quite frequently
5. Yes, all the time

Do you feel more positive and confident about your caring role?

1. No, never
2. Not usually
3. Occasionally
4. Yes, most of the time
5. Yes, always

Are you coping better financially?

1. No, not at all
2. No, I need some help
3. Yes but I could do with some help
4. Yes, most of the time
5. Yes, I am coping fine

Do you feel you have more support to cope with your caring role?

1. No, in need of substantial support
2. No, in need of moderate support
3. Not always
4. Yes, usually
5. Yes, could cope with minimal support

Do you feel you are better able to cope physically with your caring role?

1. no, not at all
2. no, not usually
3. usually
4. yes, most of the time
5. yes, all the time

Any other comments?

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