Vision Care Pathway Survey We greatly appreciate your time to fill out this survey. By filling out this brief, anonymous form, you are helping us to build better educational resources and improve your care pathway. Thank you!! Question Title * 1. What is your age? Question Title * 2. What vision condition(s) do you have? Age-Related Macular Degeneration (wet) Age-Related Macular Degeneration (dry) Bardet-Biedl syndrome Choroideremia Juvenile retinoschisis Lebers Congenital Amaurosis Retinitis Pigmentosa Stargardt disease Usher Syndrome Other (please specify) Question Title * 3. Duration of condition: YOUR CURRENT CARE AND SERVICES Question Title * 4. Which healthcare providers are part of your circle of care? (check all that apply) Family doctor Ophthalmologist Optometrist Other (please specify) Question Title * 5. What community services do you use to help with your condition? Question Title * 6. How satisfied are you with your current vision care (healthcare providers, community services, treatments, etc.) 0 1 2 3 4 0 (extremely dissatisfied) - 4 (extremely satisfied) 0 (extremely dissatisfied) - 4 (extremely satisfied) 0 0 (extremely dissatisfied) - 4 (extremely satisfied) 1 0 (extremely dissatisfied) - 4 (extremely satisfied) 2 0 (extremely dissatisfied) - 4 (extremely satisfied) 3 0 (extremely dissatisfied) - 4 (extremely satisfied) 4 Question Title * 7. Do you feel you have adequate and timely access to: (check all that apply) Family doctor Ophthalmologist Optometrist Vision-related community services and organizations Treatments and vision aids NEW treatments EDUCATION ABOUT YOUR CONDITION Question Title * 8. How do you prefer to obtain information about your condition (check all that apply) Eye Specialist Family Physician Community Service / Organizations Brochures / Pamphlets / Posters Internet Resources Conference / Events (e.g., Vision Question) Other (please specify) Question Title * 9. Have you ever been to any other educational events such as Vision Quest? No Yes (list below) YOUR NEW IDEAS AND SUGGESTIONS Question Title * 10. What services / resources do you wish were available to you, but are currently lacking? Question Title * 11. What topics would you like MORE time to discuss with your doctor at appointments? Question Title * 12. List two (2) questions that you think are KEY to ask the doctor at every eye appointment Question 1 Question 2 Done