Primary Caregiver Questions

[contact-form to=’lgdaniec@csswashtenaw.org’ subject=’Questions for Primary Caregiver’][contact-field label=’Name of Participant’ type=’name’ required=’1’/][contact-field label=’Bathing’ type=’checkbox’/][contact-field label=’Meal Preparation’ type=’checkbox’/][contact-field label=’Transportation’ type=’checkbox’/][contact-field label=’Dressing’ type=’checkbox’/][contact-field label=’Feeding’ type=’checkbox’/][contact-field label=’Medication’ type=’checkbox’/][contact-field label=’How many hours per day is care provided?’ type=’text’ required=’1’/][contact-field label=’How is your overall health?’ type=’text’/][contact-field label=’Do you have family or friends who are able to assist with care?’ type=’text’/][contact-field label=’Do you feel depressed?’ type=’text’/][contact-field label=’Do you feel you need other support or assistance to provide adequate care?’ type=’text’/][contact-field label=’What does the participant feel they would like to accomplish at The Oaks?’ type=’textarea’ required=’1’/][contact-field label=’What needs/goals would the caregiver like to see worked on?’ type=’textarea’/][contact-field label=’Anything else staff should know about the participant?’ type=’textarea’/][/contact-form]