formisoft

Caregiver Burnout Assessment Survey

Asks about caregiver name, relationship to care recipient, and care recipient's primary condition. Built for geriatric care management programs screening family caregivers for burnout risk.

Questions
13
Pages
2
Time
about 3 min

Includes

  • Consent agreement
  • Conditions checklist
  • Emergency contact
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Your practice

Caregiver Burnout Assessment Survey

Page 1 of 2 · Your information

Live preview. Tap through it like a patient.

Who it is for

  • Geriatric care management programs screening family caregivers for burnout risk
  • Hospice and palliative care teams assessing caregiver burden and support needs
  • Neurology clinics evaluating stress levels of dementia patient family members
  • Social service organizations connecting overburdened caregivers with community resources

What's inside

Page 1 · Your information

  1. Caregiver NameText
  2. Relationship to Care RecipientMultiple Choice · 7 choices
  3. Care Recipient's Primary ConditionConditions
  4. Caregiving Hours Per WeekMultiple Choice · 4 choices
  5. Types of Care ProvidedLong Text

Page 2 · Additional details

  1. Financial Strain AssessmentLong Text
  2. Self-Care & Physical Health RatingLong Text
  3. Sleep Quality & Fatigue LevelLong Text
  4. Support Resources NeededLong Text
  5. Emergency ContactEmergency Contact

From form to a ready patient

  1. The Formisoft form builder with editable questions and required toggles

    01

    Make it yours

    Reword, reorder, or add to the Caregiver Burnout Assessment Survey, and add your logo.

  2. A patient filling out a Formisoft form on a phone

    02

    Patients finish it at home

    A secure link by text or email, filled out on their phone before the visit. No app.

  3. The Formisoft dashboard showing how many of today's patients are ready

    03

    Your team sees who is ready

    Each visit shows as ready once its forms are in. Answers land on the patient record.

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Questions

Responses are encrypted, only your team can see them, and a BAA is included.

Yes. You can add, remove, reorder, or reword any of the 13 fields. You can also add conditional logic, new pages, file uploads, e-signatures, and payment fields.

Yes. Attach the form to a visit type and every patient who books gets it right away, with a reminder before the visit if it is not done. Your calendar shows which visits are ready.

Send it before the visit, so patients arrive ready.

Book a short call and we will set up the Caregiver Burnout Assessment Survey for your practice, ready to send before the next visit.

BAA included · We set up your front desk

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