--- generated_by: surveylegend-page-markdown title: Family Caregiver Needs Survey Template | SurveyLegend description: Identify service information, access barriers, scheduling needs, and contact preferences with seven questions for adult family caregivers. canonical: https://www.surveylegend.com/survey-examples-templates/personal-life-relationship-surveys/family-needs-template/ --- # Family Caregiver Support Needs Survey Template This family caregiver support needs survey template asks adult caregivers about finding services, the support they need next, barriers to access, scheduling, and a preferred first contact. Use the answers to choose one practical service improvement without collecting a care recipient's diagnosis or identity. [Try this template ](https://app.surveylegend.com/register/)[Preview template](https://www.surveylegend.com/survey-examples-templates/personal-life-relationship-surveys/family-needs-template/#try-template) Preview on a device Show the desktop survey layout Show the tablet survey layout Show the mobile survey layout ![](https://www.surveylegend.com/survey-template-media/demo-backgrounds/family-needs-template-background.avif) **SurveyLegend** 1 / 7 Family Caregiver Support Needs Survey During the past three months, how easy or difficult was it to find clear information about relevant local services or support? Very easy Easy Neither easy nor difficult +3 more answer choices Next → Family Caregiver Support Needs Survey [Preview](https://www.surveylegend.com/survey-examples-templates/personal-life-relationship-surveys/family-needs-template/#try-template) Share [Facebook ](https://www.facebook.com/sharer/sharer.php?u=https%3A%2F%2Fwww.surveylegend.com%2Fsurvey-examples-templates%2Fpersonal-life-relationship-surveys%2Ffamily-needs-template%2F)[LinkedIn ](https://www.linkedin.com/sharing/share-offsite/?url=https%3A%2F%2Fwww.surveylegend.com%2Fsurvey-examples-templates%2Fpersonal-life-relationship-surveys%2Ffamily-needs-template%2F)[X ](https://x.com/intent/tweet?url=https%3A%2F%2Fwww.surveylegend.com%2Fsurvey-examples-templates%2Fpersonal-life-relationship-surveys%2Ffamily-needs-template%2F\&text=Family%20Caregiver%20Support%20Needs%20Survey%20Template)[Reddit](https://www.reddit.com/submit?url=https%3A%2F%2Fwww.surveylegend.com%2Fsurvey-examples-templates%2Fpersonal-life-relationship-surveys%2Ffamily-needs-template%2F\&title=Family%20Caregiver%20Support%20Needs%20Survey%20Template) This family caregiver support needs survey template asks adult caregivers about finding services, the support they need next, barriers to access, scheduling, and a preferred first contact. Use the answers to choose one practical service improvement without collecting a care recipient's diagnosis or identity. ## When to use this family caregiver support needs survey Use this template when a local program needs structured feedback from adults who help an older family member living in the community. Name the service area and the three-month reference period. Explain that the survey is for planning and does not replace urgent, medical, legal, or safeguarding support. ## What the answers help you decide The questions distinguish information access from service availability, trust, timing, cost, and care-recipient preference. Results can guide one next step, such as simplifying a service directory, adding a named contact, or reviewing appointment hours. This questionnaire does not diagnose need, measure caregiver burden, or determine eligibility. **Create your family caregiver support needs survey in SurveyLegend** Use this template when a local program needs structured feedback from adults who help an older family member living in the community. Name the service area and the three-month reference period. ## Seven questions for your family caregiver support needs survey Please answer about your experience helping an older family member during the past three months. Do not include names, diagnoses, addresses, or other identifying details. Every question is optional. Try the survey ## A little feedback. A clearer picture. Explore this 7-question example at your own pace. Every question is optional. Preview on a device Show the survey at full desktop width Resize the survey to a tablet-width preview Resize the survey to a mobile preview with scrolling inside the frame Choose a look Use Classic: a white survey card over the background photo Use Light: dark text over a light tint covering the background photo Use Dark: light text over a dark tint covering the background photo SurveyLegend demo Question 1 of 7 ### Family Caregiver Support Needs Survey 01 During the past three months, how easy or difficult was it to find clear information about relevant local services or support? Choose one answer, or skip this question. Very easy Easy Neither easy nor difficult Difficult Very difficult I did not look for information 02 Which type of support would make the biggest practical difference during the next month? Choose one answer, or skip this question. Short-break or respite support Practical help at home Transport Emotional or peer support Caregiving skills or training Benefits or financial information A named person who can explain options Another type No support needed right now 03 What has most limited your use of available support? Choose one answer, or skip this question. I did not know where to start The support was unavailable when needed Cost Travel or transport The service did not feel trustworthy or suitable The person I support did not want it I preferred to manage without services I experienced no barrier Another reason 04 How well do available services fit the times when you can use them? Choose one answer, or skip this question. Very well Well Neither well nor poorly Poorly Very poorly I have not tried to use a service 05 Who would you prefer as your first point of contact when you need help finding support? Choose one answer, or skip this question. A named care coordinator A family doctor or health professional A community or nonprofit organization A peer caregiver An online service directory A telephone information line Another contact No preference 06 How would you prefer that first contact to respond? Choose one answer, or skip this question. Telephone call Text message Email Video call In-person appointment Secure online message No preference Another method 07 What is one change that would make support easier for you to find or use? Share your answer, or skip this question. #### One last look Review your answers before submitting this demo. 0 answered #### Thank you for trying the survey! You’ve tried the template from the respondent’s side. Make it your own with SurveyLegend. [Create your own survey](https://www.surveylegend.com/register/) Checking submission availability… This is a demo. We count starts and submissions only. Your answers stay in your browser and are never sent or saved. **—**Starts **—**Submissions Activity is temporarily unavailable. ## Adapt the family caregiver support needs survey to your audience Replace “local services” with the actual service area and list only support types the program can discuss or refer to. Keep “no support needed” and “I did not look” options so respondents are not forced into a problem frame. Review [sensitive questions ](https://www.surveylegend.com/survey-questions/sensitive-survey-questions/)before adding health, financial, or family details. Add urgent-help information outside the questionnaire when the topic warrants it. ## Printable family caregiver support needs survey Use the printable version at a caregiver meeting, library help desk, or community appointment for adults who prefer paper. Provide a sealed return option and a named review date. Ask staff to redact accidental names or health details before coding. Paper responses are not automatically added to online results. ![First page of the printable Family Caregiver Support Needs Survey Template with questions and answer spaces](https://www.surveylegend.com/survey-template-media/pdf-previews/family-needs-template-pdf-preview.avif) [![](https://www.surveylegend.com/user-guide-media/icons/download-pdf.svg) Download the family caregiver support needs survey PDF](https://www.surveylegend.com/downloads/survey-templates/family-caregiver-support-needs-survey-template.pdf) Export family caregiver support needs survey as PDF ## Create your family caregiver support needs survey with an AI prompt Use the complete prompt below with an AI assistant to draft this questionnaire, then register with SurveyLegend and build or customize the survey. Compare the result with the exact questions and settings before sharing. Copying the prompt does not transfer it into SurveyLegend. Create your family caregiver support needs survey with an AI prompt [](https://www.surveylegend.com/register/) Copy the prompt into an AI assistant to draft the questions, then build your survey in SurveyLegend. Already have an account? [Sign in](https://app.surveylegend.com/login/) to create your family caregiver support needs survey after copying the prompt. ## Interpret your family caregiver support needs survey responses Report each question separately. Cross-check the most requested support with the main barrier and preferred contact, but do not create a burden or risk score. Treat open responses as planning suggestions, remove identifying details before sharing, and use SurveyLegend's [open-ended analysis ](https://www.surveylegend.com/how-to-analyze-survey-results/open-ended-data/)guidance. Do not infer unmet clinical need from a missing response. Macleod and colleagues interviewed 24 family caregivers of community-dwelling people with dementia in Australia. Their abstract identifies “the inability to find information about relevant services or support” among the barriers and an expert point of contact among the facilitators. Read the [PubMed abstract ](https://pubmed.ncbi.nlm.nih.gov/28351450/). The qualitative study is dementia- and Australia-specific; it informs the information, barrier, flexibility, and contact dimensions but does not validate this broader questionnaire. ## Frequently asked questions ### Who should answer this family caregiver needs survey? Adults who help an older family member living in the community can answer. The introduction should name the service area and time period so respondents know which experience to consider. ### Is this a caregiver-burden assessment? No. The seven questions cover service information and access. They do not produce a clinical score, diagnose stress, or determine whether someone is eligible for support. ### What should the organization do with the results? Choose a specific planning decision before launch. For example, compare the most requested support with the main access barrier and preferred contact channel, then document one improvement and how progress will be reviewed. Personal Life & Relationships Survey Templates 1. [![Preview of the Couples Household Responsibilities Survey Template showing its first question and answer choices](https://www.surveylegend.com/survey-template-media/previews/couples-template-preview.avif) Couples Household Responsibilities Survey Template Personal life & relationships Finishing a task is only one part of keeping a home running. Someone also notices what is needed, plans the next step and follows up. Use this SurveyLegend questionnaire to make those parts of one responsibility easier to discuss, without turning the conversation into a compatibility score.](https://www.surveylegend.com/survey-examples-templates/personal-life-relationship-surveys/couples-template/) 2. 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