Alberta Caregiver College

Home
Complete a feedback

Your History as a Caregiver

1. How long have you been a caregiver?

0 – 3 months
4 – 12 months
1 – 5 years
> 5 years - answer question 1a

1a - Number of years you have been a caregiver (6 - 70)

2. You are the caregiver for

a parent
a child
a spouse/life partner
a family member or friend
none of the above

3. Age of the person you are caring for

0 – 5 years
6 – 10 years
11 – 18 years
19 – 30 years
31 – 65 years
66 – 75 years
76 – 85 years
85 and older

4. Type of disability (check all that apply):

Alzheimer’s disease/Dementia
Multiple Sclerosis
Parkinson’s disease
COPD/CHF
ALS/Lou Gehrig’s disease
Other chronic, degenerative disability/disease
Cerebral Palsy
Spina Bifida
Down Syndrome
Other congenital/genetic disabilities
Brain injury/trauma
Spinal cord injury/trauma
Other acute injury/trauma
Addictions/substance abuse
Schizophrenia
Other mental health illness/disorder
Other condition not included above (answer question 4a)

4a - Specify other condition

5. Do you currently have formal support (respite care, paid housekeeping or homecare, other professional services, etc) for helping you with caregiving?

Yes
No

6. Do you currently have informal support (family, friends, other unpaid services) for helping you with caregiving?

Yes
No

Previous activity ◄ Contact Us

Jump to...

Home

Accessibility settings

Stay in touch

http://caregivercollege.ca
780.735.8283
carol.wilson@albertahealthservices.ca

Data retention summary

Proudly made with

Made with by conecti.me