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Email Address:



What is your age?

What is your gender?

Are you working?

What type of housing do you currently reside in?

What is your highest educational qualification attained?

What is your occupation?

What is your monthly income?

How many people are staying in the same household as you?

Are you staying with a person with dementia?

What is your role in the care of a person with dementia?

Which support group or organization are you registered with?

How are you related to a person with dementia?

How many hours a day do you spend looking after the person with dementia? Please indicate the number of hours: