Phone Number?^*

Age (as at last birthday)?^*

Gender?^*

Religion?^*

Level of education?^*

Occupation?^*

Age of toddler/child with Cerebral Palsy?^*

Gender of toddler/child with cerebral palsy?^*

Do you feel you don’t have enough time for yourself?^*

Do you feel stressed between caring and meeting other responsibilities?^*

Do you feel angry when you are around your child?^*

Do you feel your child affects your relationship with others in a negative way?^*

Do vou feel strained when are around vour child?^*

Do you feel your health has suffered because of your involvement with your child?^*

Do you feel you don’t have as much privacy as you would like, because of your child?^*

Do you feel your social life has suffered because you are caring for your child?^*

Do you feel you have lost control of your life since vour child’s illness?^*

Do you feel uncertain about what to do about your child?^*

Do you feel you should be doing more for your child?^*

Do you feel you could do a better job in caring for your child?^*