Thank you for completing this survey. It should only take two minutes to complete.
How old are you? How old is the person for whom you care? Your gender? The gender of the one for whom you care? Relationship to care receiver Are you employed in addition to caregiving? How many hours do you work at your job? Who is the main source of your emotional support? What is your religious affiliation if any? In months, how long have you been caregiving? To whom do you turn for advice and guidance concerning your caregiving? How would you rate your spiritual wellness? How often do you feel depressed, if at all? How often do you attend religious services? How often do you pray? How often do you just talk to God? How would you rate your physical health? How would you rate your the quality of your relationship with the one for whom you care? In a crisis, to whom do you turn for help? Given the opportunity I would quit caregiving When you talk with God, does God answer your questions? If you pray, does God answer your prayers? For the following three questions use: 1 for never, 2 for seldom, 3 for sometimes, 4 for frequently, 5 for always Use: 1 for never, 2 for once a year, 3 for monthly, 4 weekly, 5 for bi-weekly Do you feel supported by your faith-community?: How would you rate your emotional wellness?: Use: 1. for very poor, 2. poor, 3. fair, 4. good, 5. excellent Use: 1. for very poor, 2. poor, 3. fair, 4. good, 5. excellent Use: 1. for very poor, 2. poor, 3. fair, 4. good, 5. excellent Use: 1. for very poor, 2. poor, 3. fair, 4. good, 5. excellent
Desert Ministries, Inc. (c) 2005