Caregiver Self-Assessment Questionnaire
Tools and Tips
The Caregiver Health Self-Assessment Questionnaire was originally developed and tested by the American Medical Association.
The questionnaire can help caregivers look at their own behavior and health risks. With their healthcare provider's help, this questionnaire can also help caregivers make decisions that may benefit both the caregiver and the older person.
In turn, the questionnaire can help healthcare providers to identify and provide preventive services to an at-risk population which may be hidden. It may also improve communication and enhance the healthcare provider-caregiver health partnership.
This questionnaire is meant to serve as a guide only.
Be sure to speak to your healthcare provider about any concerns you may have about the questionnaire or your results.
Click here to take the online interactive caregiver health assessment.
You can also download and print a version of the questionnaire below.