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Carer Questionnaire Nov 2014-1
Carer Questionnaire Nov 2014-1
CARERS
Name (optional)
Contact telephone number
Age range:
18-45
46-65
65+
Other
Learning disabilities
disability
A child with
Physical disabilities
Mental Health
Sensory Services
Alzheimers/Dementia
Older people/frailty
Substance misuse
Autism/ADHD
Please tell us about the services you have used within the last
twelve months
Adult Carers: registration, information and support
one support
Befriending Service
Advocacy
One to
Carer Forums
Coffee Morning
Bowling
Craft sessions
Ten Pin
Carer events/
Fitness
outings
Good
Poor
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Are there any other ways we can help you?
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We understand that Carers can be inundated with forms but would like to
stress that the information you provide will be put to good use and could help
to protect the services we offer.
Thank you for your support, please return this questionnaire to:
Adult Carers Project, CAST, 1 Beach Rd, South Shields, Tyne & Wear, NE33 2QA