Caregiver and family support survey template
Whether families were informed, involved and given practical instructions, and what support they need themselves.
3 questions · about 3 minutes to complete · free on every plan
Free account required. The template is copied into your workspace; edit anything before publishing.
- When to use it
- After a care episode or at a review.
- Who it is for
- Family members and carers of patients.
How to use this template
- Keep language plain and avoid medical jargon.
- Offer the survey in the family's language.
- Read open-text answers from the lowest scorers first; they explain the numbers.
Questions in the caregiver and family support survey template
1. Please rate your agreement:
matrix · I was kept informed about the person I care for, I was involved in decisions where appropriate, I received practical instructions I could follow, I know who to contact with questions, Staff treated me with respect
2. What support would help you as a carer?
multi choice · Written information, A named contact, Respite or breaks, Training in care tasks, Peer support groups, Financial guidance, None of these
3. What would have made this easier for you?
open text
What the results look like
IllustrativeSynthetic sample of 120 responses generated for this preview, not real survey data. Your results page shows the same charts for your own responses.
1.Please rate your agreement:
120 answered| Statement | Strongly disagree | Disagree | Neutral | Agree | Strongly agree | n |
|---|---|---|---|---|---|---|
| I was kept informed about the person I care for | 8% | 12% | 21% | 28% | 33% | 120 |
| I was involved in decisions where appropriate | 7% | 12% | 16% | 30% | 36% | 120 |
| I received practical instructions I could follow | 8% | 12% | 11% | 33% | 38% | 120 |
| I know who to contact with questions | 10% | 17% | 23% | 16% | 35% | 120 |
| Staff treated me with respect | 11% | 13% | 20% | 25% | 32% | 120 |
2.What support would help you as a carer?
114 answered| Answer | Count | Percent |
|---|---|---|
| Written information | 28 | 25% |
| A named contact | 27 | 24% |
| Respite or breaks | 69 | 61% |
| Training in care tasks | 75 | 66% |
| Peer support groups | 52 | 46% |
| Financial guidance | 44 | 39% |
| None of these | 5 | 4% |
How to read these questions
- matrix: Compare rows on the same column (for example, % agree) to find the weakest statement, then look at who rates it lowest.
- multi choice: Percentages add up to more than 100% because people can pick several. Compare options by share of respondents, not share of picks.
Frequently asked questions
What should a caregiver survey cover?
Whether they were kept informed, involved in decisions, given practical instructions, and know who to contact; plus their own need for support.
How long does the caregiver and family support survey take to complete?
About 3 minutes: 3 questions, most of them single-tap. Every question can be edited, removed or reordered in the builder before you publish.
Is this template free to use?
Yes. Every template is included on the Free plan. Sign up, click Use this template, and it is copied into your workspace where you can edit it, add your logo and share it by link, email or embed.
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