Carer Questionnaire

If you are a carer we would really appreciate it if you could answer the questions on this form.

Your answers will tell us how we can best support you as a carer both now and in the future.

Carer Questionnaire

Section

Please tell us your age range:

Read each of the following statements about The Loddon Vale Practice and mark which best describes how much you agree or disagree with the statement:
My physical health is worse
I have injured myself through lifting or moving someone
My mental health is worse
I have put off seeing a GP when I was unwell
I have put off medical treatment
I have had to stop working
I feel isolated
I find it hard to leave the person I care for to attend an appointment
It is difficult for me to bring the person I care for to the GP practice

Read each of the following statements about how The Loddon Vale Practice supports you as a carer and then mark which best describes how much you agree or disagree with the statement:
As a carer, I feel supported by the practice
When I have concerns about the person I look after, I feel able to talk to someone
The doctors and nurses know that I am a carer
The practice has given me information for me to help care for the person I look after
The practice has referred me to local services to help me care for the person I look after
The practice encourages carers to let them know they are carers

Thinking about how the practice could support you as a carer, how helpful would the following be to you:
Being called in for a health check
Flexible appointments
A free flu vaccination
Support to improve my physical health
Support to improve my mental health
A referral to local services and or carers centre