1. Please give your name, and email address or phone number:
2. How well do you feel you are coping with being a carer? Zero: you are not coping well at all. Ten: you feel that you are coping very well with being a carer.
3. Health and Fitness - How happy are you with your health and fitness? Zero: you are not happy at all. Ten: you are very happy with your health and fitness.
4. How happy are you with your social life? Zero: you are not happy at all. Ten: you are very happy with your social life.
5. How well do you feel you look after yourself? Zero: you feel that you do not look after yourself very well at all. Ten: you feel that you look after yourself very well.
6. As a carer, how well do you know your rights? Zero: you do not know your rights at all. Ten: you know your rights very well.
7. How aware are you of services available to yourself and the person you care for? Zero: you are not aware at all. Ten: you are very aware of services available to yourself and the person you care for.
8. How well supported do you feel? Zero: you do not feel supported at all. Ten: you feel very supported.
9. How happy are you at this time in your life? Zero: you are not happy at all. Ten: you are very happy at this time in your life.
10. How confident are you about your future? Zero: you are not confident at all. Ten: you are very confident about your future.