Fact-G Caregiver

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Closes 30 Jun 2022

Introduction

1. PHYSICAL WELL-BEING

Below is a list of statements that other people facing an illness have said are important.  Please circle or mark one number per line to indicate your response as it applies to the past 7 days.

2. SOCIAL/ FAMILY WELL-BEING

Below is a list of statements that other people facing an illness have said are important.  Please circle or mark one number per line to indicate your response as it applies to the past 7 days.

If you prefer not to answer the question below please go to the next section.

3. EMOTIONAL WELL-BEING

Below is a list of statements that other people facing an illness have said are important.  Please circle or mark one number per line to indicate your response as it applies to the past 7 days.

4. FUNCTIONAL WELL-BEING

Below is a list of statements that other people facing an illness have said are important.  Please circle or mark one number per line to indicate your response as it applies to the past 7 days.