D.O.S. Caregiver Checklist
  • Doses of Sunshine, LLC

    Caregiver Evaluation Form
  • Which best describes your relationship with the patient?
  • 1. Do you struggle with caring for your loved one?
  • 2. Are you unsure what to do next in your loved one’s care?
  • 3. Do you feel as though you have the necessary resources (i.e. time, money and/or support) to care for your loved one?
  • 4. Do you struggle to communicate with family about care responsibilities?
  • 5. Do you often feel invisible or misunderstood by friends or family?
  • 6. Are you managing care while also working, parenting, or supporting others
  • 7. Have you delayed important decisions because you feel emotionally exhausted?
  • 8. Are you carrying emotions (grief, resentment, anxiety) that you haven’t had space to process/express?
  • 9. Do you feel like you’ve lost touch with who you are outside of caregiving?
  • 10. Do you feel guilty taking time for yourself?
  • Should be Empty: