ICU Questionnaire (Family Member)

My ICU Guide - ICU Questionnaire (Family Member)

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  • Your Intensive Care Unit (ICU) staff realize that having a family member or friend in the ICU can be very stressful. The ICU may seem like a strange environment with lots of machines, noises and monitors. ICU patients are usually very sick. You may have a lot of questions about the care your family member may receive. The ICU team is here to help you get the information and support you need.

    This questionnaire will ask questions about the patient in the ICU, their values, important decision making situations, and the experience in the ICU. It is divided into 8 pages. At the end of the questionnaire, an individualized report will be generated summarizing your responses. This information may be helpful to you and can be provided to the health care team to help them better understand the patient and family. By providing your email address, you will be able to save the questionnaire to return to later and receive an emailed copy of the report.

    Please print this report and bring it to the attention of the clinical team looking after your loved one (the patient). The answers to the questions in this report will help the clinical team better understand how to provide better care to you and your family member.

  • By providing your email address, you will be able to save the questionnaire to return to later and receive an emailed copy of the report.
  • Help Us Get To Know You

  • By family, we mean two or more persons who are related in any way - biologically, legally or emotionally.

  • Depression = Feeling sad

  • Anxiety = Feeling nervous