1 Do you feel a high level of stress related to caregiving responsibilities?

Yes No

2 Do you spend the majority of your day providing care for your loved one?

Yes No

3 Are you experiencing any physical symptoms such as fatigue, headaches, or sleep disturbances due to caregiving duties?

Yes No

4 Do you feel overwhelmed or isolated in your caregiving role frequently?

Yes No

5 Have you had to make significant sacrifices in your personal or professional life due to caregiving responsibilities?

Yes No

6 Are you unable to take regular breaks or time for self-care while fulfilling your caregiving duties?

Yes No

7 Have you noticed any changes in your emotional well-being since taking on the role of caregiver?

Yes No

8 Are you finding it challenging to manage medications, appointments, or other medical aspects of care for your loved one?

Yes No

9 Have you experienced any difficulties in communicating with healthcare professionals regarding your loved one's care needs?

Yes No

10 Do you lack adequate support in your caregiving role from family, friends, or other support networks?

Yes No