If you fit multiple categories, please feel free to complete all surveys that apply to your situation.

Caregivers or Spouse Survey

Name

Age

Gender

Phone

What state are you a resident of?

Are you a caregiver or spouse to a veteran?

To help us verify with the VA that you care for a veteran, please upload a copy of the veteran's dd214, VA ID Card or a DL with the Veteran designation.

Are you receiving a stipend from the VA as a caregiver?

If you are not receiving a stipend from the VA, are you aware that you may be eligible to receive a stipend?

What is your Veterans disability rating from the Department of Veteran Affairs (VA)?

Are you aware of the services provided for your veteran through the VA?

If yes, which ones

Are you aware of the services provided to you through the VA?

If yes, which ones

Are you aware of services available to you as a caregiver through your local community and other non VA organizations?

If yes, which ones

Do you currently use the VA system or other organizations to receive any support services? If yes, what services do you receive from the VA or other organizations?

If yes, which ones

Have you ever used your local Veteran’s Service Office (VSO)?

Have you personally been affected by a veteran’s suicide?

Has the veteran you care for ever suffered from suicidal ideations?

Have you ever known a family member of a veteran who committed suicide?

Is the veteran you care for currently divorced?

What type of family services or activities would you like to see provided that you, your veteran or family would benefit from?

Were there any transitional services that would have made the transition from active duty to veteran life easier and more successful for the veteran you care for?