Aging with Support Needs in the U.S.
As family caregivers, we want to know your thoughts on aging with a loved one needing special support. How are things going? Do you have future plans? Do you have specific worries? We want to keep the conversation alive, share ideas with others and hopefully create some new solutions. 

To learn more about our organization or if you have other questions/comments/suggestions outside of the scope of this survey, please email hello@peaceofmindcommunity.com or visit our website.
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First Name
*
Last Name
*
Email *
What state do you live in? (Enter country if not in the United States) *
Your Role
*
Current age of person with support needs (Caring for more than one person with support needs? See below for additional area to add information)
*
Their first name (optional)
Level of care needed
*
If would like to share more about your loved one's diagnosis or you are caring for more than one person with support needs, tell us about them here! (Age, level of care / diagnosis)
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