Web-Based Mindfulness Parent Group Survey 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. Question Title * 1. Name Question Title * 2. Mailing Address Question Title * 3. Email Address Question Title * 4. Telephone Number Question Title * 5. How do you prefer to be contacted? Phone Email Mail Question Title * 6. Do you have a child with ASD who is 16 or older? Yes No Question Title * 7. Do you have access to a phone? Yes No Question Title * 8. Do you have access to a tablet or computer with internet? Yes No Question Title * 9. Do you have access to a web camera? Or a computer with a built-in camera? Yes No Question Title * 10. Do you have access to earbud headphones with a microphone? Yes No Question Title * 11. Have you previously participated in a mindfulness-based program? Yes No Question Title * 12. Have you previously participated in parent support groups? Yes No Question Title * 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 Done