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Name (required)

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Are you a young person with a family member who has a chronic illness, mental illness, disability, addiction or other serious illness/injury? (required)

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Do you mainly care for: (required)

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What age group do you fit into? (required)

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What is your gender? (required)

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What country do you live in? (required)

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Do you (tick as many are relevant): Clear

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In a regular week do you (tick as many as apply): Clear

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Do you miss many days of work/school each month because of your caring role?

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Do you get help from any of the following for yourself: Clear

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In general would you say your health (physical and mental) is:

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