We are researching how to support parents of adolescents and adults with autism spectrum disorder (ASD). As part of this research, we are holding a free, web-based mindfulness group for parents of adolescents and adults with ASD to help them cope. If you think this is something you might be interested in learning more about, please complete this short survey.

1.Name 

2.Mailing Address 

3.Email Address 

4.Telephone Number 

5.How do you prefer to be contacted? 

Phone 

Email 

Mail 

6.Do you have a child with ASD who is 16 or older?

Yes

No

7.Do you have access to a phone?

Yes

No

8.Do you have access to a tablet or computer with internet? 

Yes

No 

9.Do you have access to a web camera? Or a computer with a built-in camera? 

Yes

No

10.Do you have access to earbud headphones with a microphone? 

Yes

No 

11.Have you previously participated in a mindfulness-based program? 

Yes

No 

12.Have you previously participated in parent support groups? 

Yes

No 

13.The groups will run for 6 weeks on Tuesdays from 1:00-2:30pm EST. The dates will be: Sept 26, Oct 3, Oct 10, Oct 17, Oct 24, and Oct 31. Are you available on these dates/at this time?

Yes 

No 

Thank you for completing this survey. Someone from the project team will contact you shortly. In the meantime, if you have further questions or would like more information, please contact Michelle at: michelle.dale@camh.ca OR 416-535-8501 x37819