Background

Thank you for agreeing to take part in this important survey. NHS West Hampshire CCG is working with carers and carer groups to decide what information and support services we need to have in place in order to help carers cope with the stress of caring.

This survey should take no longer than 5 minutes to complete. Please do not feel you have to answer all of the questions. Please be assured that all your answers you provide will be kept in the strictest confidentiality. Your responses are voluntary and will not be identified by individual.

* 1. Are you a carer? (A carer is anyone who cares, unpaid, for a friend or family member who due to illness, disability, a mental health problem or an addiction cannot cope without their support)

* 2. How many people do you care for?

* 3. Please indicate the age of the person(s) you care for? Please select all that apply

* 4. Your age group

* 5. Your gender

* 7. Does the person you care for have …? Please select all that apply

* 8. In addition to your caring role, please tell us which of the following applies to you?

* 9. Have you registered yourself as a carer at your GP Practice?

* 10. Support for caring

  Never Some of the time Most of the time Always
I have a good level of emotional support
My needs as a carer are considered by professionals
I am happy with the support provided
I feel able to get the help and information I need
I have all the practical support I need

* 11. Your emotional wellbeing

  Never Some of the time Most of the time Always
I feel depressed due to caring
I feel stressed as a result of caring
I feel anxious as a result of caring
I feel so exhausted that I cannot function properly
I am unable to see anything positive in my life
I have difficulty sleeping due to the worry or stress of caring

* 12. Please tell us how caring has impacted on your own mental health

* 13. Please tell us how caring has impacted on your own physical health

* 14. Which of the following support services have you used in your caring role? Please select all that apply.

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