Caregiver Support Series Pre-Survey What is today’s date? * (MM/DD/YYYY) Enter your birthday * (MM/DD/YYYY) First * First Last Last Email * Which answer best describes your current knowledge about caregiving? * Excellent Good Fair Poor How would you rate your understanding of dementia? * Excellent Good Fair Poor How would you rate your confidence in being a caregiver? * Excellent Good Fair Poor How would you rate your understanding of where to find help and resources?? * Excellent Good Fair Poor Next We would like to follow up with you in 30-45 days after your participation in this program. * I approve a follow up contact. I do not approve a follow up contact. Remember that your approval helps us to ensure that our programs are of value to our community. If you are human, leave this field blank. Submit
