The Family Survey Please complete these questions if you are a family member of our resident. Resident Name* First Last Your Name* First Last Your Email* Your Phone*I would consider my knowledge of Alzheimer's and dementia related disease to be...*NoneFairGoodExcellentI would consider the knowledge of other members of our family to be...*NoneFairGoodExcellentDo you feel you have less time for yourself due to the time you spent caring for your loved one?*YesNoAre you are afraid or concerned for what the future holds for your loved one?*YesNoDo you feel stressed between caring for your loved one and trying to meet other responsibilites for your family or work?*YesNoDo you feel uncertain about what to do for your loved one?*YesNoDo you feel your health has suffered due to your involvement of your loved one?*YesNoPlease explain what your hopes are for the future and what Peregrine can do to fulfill them.*The decision to move your loved one into assisted living made by...*Check all that apply Me Other family members A doctor If you chose other family or doctor in the previous question, please include the names of the other family members, or explain the doctor's reasoning.The decision to make this move was...*Check all that apply For safety reasons For our loved one to have more stimulation Difficulty balancing our own life and providing care to our loved one The spouse who was the primary caregiver died Other If deceased, when did the spouse of your loved one die?Who was the primary caregiver, if any, prior to admission?*Which of the following educational programs do you think you would benefit from?Check all that apply Nomal Aging/Alzheimer's/Dementia: Diagnosis, Prognosis, Treatment Walk a day in their shoes - Sensitivity Training How to have a successful visit with your loved one Basic approaches to dementia care Understanding the environment through the eyes of dementia Communication and feeling Behavioral management Personal care: bathing, dressing, nutrition Management and recognition of pain Activities for persons with dementia Safeguarding and administering medications Family support and customer service Spiritual care and preparing for end of life Types of dementia The Validation Method Finding joy: "how to laugh and love" Recording your legacy story How to explain Alzheimer's and dementia to children Creating keepsake boxes Using the 5 love languages with Alzheimer's How to deal with the stress of the holidays while caring for your loved one Any other commentsWhich location does your loved one live at?*CT Clinton - Peregrine's Landing at the ShorelineGA Decatur - Peregrine's Landing at Emory HeightsGA Norcross - Peregrine's Landing at Holcomb BridgeGA Smyrna - Peregrine's Landing at Peachtree CreekMA Tewksbury - Peregrine's Landing at TewksburyMD Baltimore - Peregrine's Landing at Tudor HeightsNY Cheektowaga - Peregrine's Landing Senior CommunityNY Clifton Park - Beacon Pointe Memory Care CommunityNY Greece - Crimson Ridge Gardens Memory CareNY Greece - Crimson Ridge Meadows Assisted LivingNY Skaneateles - The Athenaeum at SkaneatelesNY Orchard Park - Peregrine's Landing at Orchard ParkNameThis field is for validation purposes and should be left unchanged.