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Home > Questionnaires > For Family

Questionnaires for Family

The following questionnaire is provided to allow the families to self asscess their own needs.

In today’s world of two working parent families, increased stress and loss of our extended family it is often difficult for families to cope. Everyone wants to enjoy their time with their families. Sometimes complications happen, stress mounts, and anxiety sets in. The following questionnaire is designed to highlight some of the often unavoidable stress points in today’s families' lives.

Are you pregnant Yes No
Do you have complications in your pregnancy Yes No
Do you have multiple children under age 5 Yes No
Are one or both parents in high stress jobs Yes No
Are you a single parent Yes No
Do you have a child with developmental needs Yes No
Is a family member hospitalized Yes No
Did you have recent surgery or major illness Yes No
Do you have minimal time for shopping Yes No
Do you have minimal time for meal preparation Yes No
Are you isolated or shut in for any reason Yes No
Have you had a recent life altering event Yes No

If you answered yes to:

1-3 We are here to help.
4-7 Our services could be considered.
8-13 Call us today. We can help bring balance to your life.

For more information call 1-877-301-2092 or email us at ssartin@compassionateadvantage.ca

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