First Name *

Last Name *

Email *

SECTION 1: About You & Your Journey

Where are you in your caregiving journey? *

Other (Type Short Answer):

What’s been the hardest part of this journey for you so far? (Short Paragraph) This can be emotional, logistical, physical — whatever comes to mind first. *

SECTION 2: Types of Support

What kind of support do you WISH you had right now? (Checkboxes – select all that apply) *

Help understanding medical terms and treatment options

Someone to guide me through what questions to ask at appointments

Nutrition or meal guidance

Managing all the emotions that come with caregiving

Financial or insurance-related help

Help getting family and friends on the same page

Encouragement from someone who gets it

Something else: [Short answer]

SECTION 3: Learning Preferences

If I could offer you helpful tools, guidance, or support, how would you prefer to receive it? *

What would help you feel less alone on this journey? (Short paragraph) There’s no right answer — just be real. *

SECTION 4: Timing & Access

Realistically, how much time do you have per week to receive support? *

SECTION 5: Value & Future Support

If there were a support system, tool, or space created just for caregivers like you…What would make it so valuable that it would be worth paying for (even if only a small amount)? (Short paragraph) *

You’re not committing to anything — I just want to understand what you truly need and would find worth your time, energy, and investment.

CLOSING

Is there anything else you wish someone would create to make this journey less overwhelming? (Short paragraph) *

Would you like to be updated when new caregiver tools or resources become available? Only if you'd like — I won’t spam you or share your info. This is just a way to stay connected. *