Partnership for Parents: An Online Guide for Parents of Seriously Ill Children

User Survey
The ultimate purpose for this survey is to improve the availability of quality services for you and your child between hospitalizations. Please think about the care your child and your family received or are receiving during treatment while your child was/is at home. Thank you for taking a few moments to answer these questions.

Let's get started...
There are 9 questions in this survey.

Which state do you live in?
Choose only one of the following

What was your child’s primary diagnosis?

During your child’s treatment, which of the following did you receive on a regular basis while your child is/was at home (between hospitalizations)?
Check any that apply

In-home nursing visits
24/7 on call nursing
Support from a social worker for your family
Spiritual support from a chaplain or other clergy
Volunteer visitor or volunteers helping with daily chores
Respite care (someone who cared for your child so you could rest)
Bereavement/grief support if your child died
Our child did not receive these services on a regular basis
Other:

Of the services listed above, which would be helpful to your family while your child is/was at home (between hospitalizations)?
Check any that apply

Does your insurance cover these services at home?
Choose only one of the following

Yes
No
Unsure
No answer

Please choose the statement that best describes your experience using this website.
Choose only one of the following

Excellent - I found extremely helpful information and will recommend the site to other parents.
Good - I found some useful information on the site.
Poor - I found little helpful information on this site.
No answer

Is there anything else you would like to share with us about your child or your child's care?