Steady Hearts — Pathways & Packages Assessment (v2)

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This form helps us recommend the right Support Pathway and Support Package before your intake call. There are no "right" or "wrong" answers. Your responses help us prepare and support you well.
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Note: To ensure we can continue offering reduced-rate support, families selecting our lowest-cost pathways may be asked to provide a simple form of income or benefits verification. We keep this process minimal, respectful, and private.
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Q1. Which statement best reflects your current situation?(Select one)
We are experiencing significant financial strain and need the most affordable support possible right now.
We are on a fixed or limited income and need flexible, lower-cost support.
We have some financial stability and are able to invest in ongoing advocacy support.
We are financially stable and are seeking comprehensive, high-touch support.
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Q2. What are you hoping support will help with most right now?(Select all that apply)
Understanding diagnosis, scans, or labs
Preparing for appointments or second opinions
Organizing medications, records, or schedules
Coordinating care between providers
Ongoing caregiver support and guidance
Navigating advanced illness or care transitions
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Q3. How urgent does support feel right now?(Select one)
Immediate (appointment or decision within 72 hours)
Soon (appointment/decision within 1-2 weeks)
Unsure
Ongoing support, not time-sensitive
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Q4. How many medical providers are currently involved in care?(Select one)
1 provider
2 providers
3-4 providers
5+ providers
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Q5. Are there active treatments or procedures underway or scheduled?(Select one)
No / monitoring only
Yes, routine or maintenance
Yes, major treatment (chemo/radiation/surgery)
Multiple or overlapping treatments
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Q6. How often does coordination currently feel necessary? (Select one)
Monthly or less
Weekly
Multiple times per week
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Q7. Who is currently managing most care coordination tasks?(Select one)
Patient
One caregiver
Shared among family/friends
No one / it feels unmanaged
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Q8. How confident do you feel keeping track of appointments, results, and next steps?(Select one)
Confident
Somewhat confident
Not confident
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Q9. What best describes your role? (Select one)(Select one)
Patient
Primary caregiver
Shared caregiver (family/friends)
Adult child caring for parent
Spouse/partner
Other
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Q10. How comfortable are you with digital tools (apps, online forms, etc.)?(Select one)
Very comfortable
Somewhat comfortable
Prefer minimal digital tools
Prefer mostly printed support
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Q11. Is there anything you'd like us to know about your situation right now?
Should be Empty: