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Pre-Program Survey

Please complete this short survey to provide the information we need to confirm your account in our system and to provide a good understanding of where you are starting this program.

Click the button below to start.

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Question 1 of 12

What is your name?

Question 2 of 12

What is your email address? (Please use the email address that you will use to log on to your educational portal.)

Question 3 of 12

What is your shipping address? (We will be shipping you some course materials in the mail)

Question 4 of 12

Describe a bit about the parent(s) you are caring for or supporting.

Question 5 of 12

If you were to introduce yourself on The Village, our private Facebook group, what would you say?  (We will use this when we welcome you to the group)

Question 6 of 12

What is your biggest emotional challenge when  it comes to supporting your parent?  Ultimately, why did you choose to join Love and the Art of Aging Parent Care right now?

Question 7 of 12

What would be your ideal parent care outcome? AKA what are you hoping to learn or accomplish by joining Love and the Art of Aging Parent Care?

Question 8 of 12

How do you rate your level of parent care related stress/frustration right now?

A

1 - Very Stressed/frustrated

B

2 - Stressed/frustrated

C

3 - Fair Amount of Stress/frustration

D

4 - Above Average Stress/frustration

E

5 - Average Stress/frustration

F

6 - Below Average Stress/frustration

G

7 - Good Stress/frustration Level

H

8 - Very Good Stress/frustration Level

I

9 - Excellent Stress/frustration Level

J

10 - Outstanding Stress/frustration Level (zero stress/frustration)

Question 9 of 12

How do you rate your level of parent care related worry/anxiety right now?

A

1 - Extreme Worry/Anxiety

B

2 - Very Worried/Anxious

C

3 - Fair Worry/Anxiety

D

4 - Above Average Worry/Anxiety

E

5 - Average Worry/Anxiety

F

6 - Below Average Worry/Anxiety

G

7 - Good Worry/Anxiety

H

8 - Very Good Worry/Anxiety

I

9 - Excellent Worry/Anxiety

J

10 - Outstanding Worry/Anxiety (Zero worry/anxiety)

Question 10 of 12

How do you rate your level of connectedness with your parent right now?

A

1 - Very Poor

B

2 - Poor

C

3 - Fair

D

4 - Below Average

E

5 - Average

F

6 - Above Average

G

7- Good

H

8 - Very Good

I

9 - Excellent

J

10 - Outstanding

Question 11 of 12

How would you rate your ability to talk to your parent about difficult things related to them right now?

A

1 - Very Poor

B

2 - Poor

C

3 - Fair

D

4 - Below Average

E

5 - Average

F

6 - Above Average

G

7 - Good

H

8 - Very Good

I

9 - Excellent

J

10 - Outstanding

Question 12 of 12

How would you rate your level of peace/calmness related to parent care right now?

A

1 - Very Poor

B

2 - Poor

C

3 - Fair

D

4 - Below Average

E

5 - Average

F

6 - Above Average

G

7 - Good

H

8 - Very Good

I

9 - Excellent

J

10 - Outstanding (incredible peace/calmness)

Confirm and Submit