Name
*
First Name
Last Name
Email Address
*
Phone
*
(###)
###
####
Who are you caring for? (e.g., parent, spouse, child, friend, other)
*
How long have you been a caregiver?
*
Less than a year
1-3 years
3-5 years
5+ years
What inspired or required you to take on the caregiving role? (A brief description of how you became a caregiver.)
What has been the most rewarding part of caregiving for you? (This could include moments of connection, gratitude, or personal growth.)
What has been the most challenging aspect of caregiving? (This could include specific struggles, emotional tolls, or obstacles you’ve faced.)
Have you received support during your caregiving journey? If so, what kind of support has been most helpful? (This could include family, friends, organizations, or resources.)
What lessons have you learned through caregiving that you’d like to share with others? (This could be advice, coping strategies, or insights about life and caregiving.)
What additional support would make a difference in your caregiving journey? (This helps identify gaps in resources and services caregivers need.)
If you could share one message about caregiving with the world, what would it be?
Would you be willing to participate in a follow-up interview or event?
Anything else you'd like to add?
