This survey was developed by parents from Family Voices organizations in several states.  Family Voices is staffed by parents of children who have special health care needs or disabilities.  Our goal for this survey is to learn from and better understand what other parents want and find helpful from their child's doctors.  

This is an anonymous survey. We cannot identify who you are from your survey answers. Your answers will be combined with those from other parents.  This will give us a summary so we can all better understand what is helpful to families in general.   We will use this information in our work to improve the healthcare system.

This survey contains 18 questions and should take about ten minutes to complete.

Thank you for taking the time to fill out the survey and sharing your ideas with us.  If you have any questions or want more information about this survey, please contact Carolyn Allshouse at Carolyn@familyvoicesmn.org.

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* 1. What is the age of your child with special health care needs or disabilities? (If you have more than one child with special health care needs, please think of the child you think has the most complex needs.)

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* 2. How many conditions has your child been diagnosed with?

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* 3. Does your child have a primary care doctor (e.g. a pediatrician or family practice doctor)? 

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* 4. How often does your child's primary doctor talk to the other doctors or professionals your child sees to make sure they're all on the same page?

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* 5. Number of specialty doctors or other health care providers involved in your child's care?

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* 6. Does your child have any technology needs (includes feeding tube/pump, ventilator, oxygen, etc.)?

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* 7. How many times has your child been hospitalized in the past year?

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* 8. What do you want from your child's doctors? (Please list 3 to 5 qualities, activities or actions that would demonstrate what is important to you).

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* 9. Please name a specific thing that one of your child's doctors is doing that you find useful. (Please think of any of your child's doctors).

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* 10. Please name a specific thing that one of your child's doctors is doing that you don't find useful?(Please think of any of your child's doctors).

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* 11. How would you rate your ability to access your child's doctor when needed?

  During regular office hours During evening hours On the weekend
Please tell us how easy or difficult it is to access your child's doctor when needed at different times of the day:

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* 12. Please list one thing that you believe would make the healthcare system better for you and your child.

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* 13. What has been or is the most useful community support or resource to you?

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* 14. What type of insurance does your child have? (Please check all that apply)

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* 15. Does insurance cover all of your child's healthcare needs?

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* 16. What State do you live in?

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* 17. What is the highest grade or level of school that you have completed?

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* 18. What is your race or ethnicity?

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