I care for a family member
Please select
YES
NO
I do household jobs in my home e.g ironing, washing up
Please select
YES
NO
I help a family member wash themselves
Please select
YES
NO
I help a family member cook
Please select
YES
NO
I do the shopping
Please select
YES
NO
I give a family member medication
Please select
YES
NO
I help with bills
Please select
YES
NO
I have to help my family member in and out of bed, up and down stairs, in and out of the bath
Please select
YES
NO
I help my family member not to drink
Please select
YES
NO
I help my family member not to take drugs
Please select
YES
NO
I take my family member to the doctors
Please select
YES
NO
I am not always able to go out with my friends
Please select
YES
NO
I find it hard to concentrate at school because I am worried about a family member
Please select
YES
NO
I lose sleep because of a family member
Please select
YES
NO
I sometimes have to miss school because of a family member
Please select
YES
NO
I sometimes help my family member when they are sad or upset
Please select
YES
NO
My friends sometimes get angry when I can't come out
Please select
YES
NO
My friends do not sleep over at my house alot.
Please select
YES
NO
I don't sleep at my friends house
Please select
YES
NO
I sometimes feel upset
Please select
Sometimes
Always
Never
I sometimes feel angry
Please select
Sometimes
Always
Never
I sometimes feel tired
Please select
Sometimes
Always
Never
I sometimes feel frustrated
Please select
Sometimes
Always
Never
Sometimes I feel like i'm missing out
Please select
Sometimes
Always
Never
I feel embarrased about my situation
Please select
Sometimes
Always
Never
I cry alot because of my situation
Please select
Sometimes
Always
Never
I feel I have nobody to talk to
Please select
YES
NO
Sometimes i feel i'm not good enough
Please select
Sometimes
Always
Never
I feel I need help
Please select
Sometimes
Always
Never
My name:
Please contact me by:
Please select
Email
Mobile
Telephone
My contact details - mobile,email,telephone:
