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Carers In Herts
>
Tell us about your caring role
Hidden
Type of Questionnaire
Pre
Post
Hidden
Email
Hidden
PublicId
Have you checked the details in the email contract?
Tick the box to agree to the terms.
(Required)
I agree to the terms as described in the email from Carers in Hertfordshire and wish to proceed with the break.
Let us know how you're feeling at the moment.
I've been feeling optimistic about the future.
(Required)
Please select
None of the time
Rarely
Some of the time
Often
All of the time
I’ve been feeling useful.
(Required)
Please select
None of the time
Rarely
Some of the time
Often
All of the time
I’ve been feeling relaxed.
(Required)
Please select
None of the time
Rarely
Some of the time
Often
All of the time
I’ve been dealing with problems well.
(Required)
Please select
None of the time
Rarely
Some of the time
Often
All of the time
I’ve been thinking clearly.
(Required)
Please select
None of the time
Rarely
Some of the time
Often
All of the time
I’ve been feeling close to other people.
(Required)
Please select
None of the time
Rarely
Some of the time
Often
All of the time
I’ve been able to make up my own mind about things.
(Required)
Please select
None of the time
Rarely
Some of the time
Often
All of the time
What was your experience of the Make a Difference service at Carers in Hertfordshire?
Choose an option to describe the service:
(Required)
Please select
Poor
Fair
Good
Very Good
Excellent
How your caring role has changed over the last 3 months?
(Required)
Please select
Increased a lot
Increased a little
Stayed the same
Improved lots
Ceased
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