C-CART® Assessment Tool

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Demographics

Please tell us about the person you are caring for so that we can suggest the most appropriate resources. This information will also be used to refine and improve the C-CART® experience.

What is the age of the person you care for? What is your relationship with the person you care for?

I am their...

What setting does the person you care for live in? Which province/territory does the person you care for live in? Is the person you are caring for a veteran?

Yes No

Does the person you care for identify as an Indigenous Person in Canada, such as First Nation, Métis, or Inuit?

Yes No

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Knowledge of Individual’s Condition What is the condition of the person you care for? Please select all that apply:

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Additional Care Considerations Would you like to find out more information about any of the following? Please select all that apply:

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General Assessment & Resource Knowledge What are some barriers you encounter in your caregiving experience? Please select all that apply:

How often do you engage in self-care activities?

Self-care means engaging in physical activities such as exercising or eating healthy, enjoying mental activities such as reading, journaling, or taking part in social or spiritual activities including meditation, visiting friends, or any other activities that help reduce stress in your life.

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Mood How often in the last two weeks have you had little interest or pleasure in doing things?

Please select the number of days:

Not at all Several days More than half the days Nearly every day

How often in the last two weeks have you felt down, depressed, or hopeless?

Please select the number of days:

Not at all Several days More than half the days Nearly every day

In the past 12 months, have you used alcohol, prescription medications for non-medical reasons, other substances or gambling more than usual?

Yes No

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Finance How often do you have financial concerns about covering your basic necessities?

How do your caregiving responsibilities affect your employment and/or school situation?

Not affected at all Reduced work hours Sick leave Unpaid leave Had to quit school Had to quit a job Got fired from a job

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Caregiver Demographics

The following set of questions will help us better understand the Canadian caregiver population and assist us in improving the C-CART® experience.

What is your age (the caregiver)?
Which province/territory do you live in?
Do you identify as an Indigenous Person in Canada, such as First Nation, Métis, or Inuit?

Yes No

Are you part of the 2SLGBTQI+ Community?

Yes No

Please ensure to complete all sections before submitting.

Thank you for completing the Canadian Caregiver Assessment and Resources Tool (C-CART®). On the next page you will receive your personalized resources. Please click ‘Continue to Resources’ to view.
You are encouraged to save these resources for future reference.

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