You have been selected to participate in a survey for the Maternal and Child Health Block Grant Title V Needs Assessment.  The Texas Department of State Health Services would like to hear from parents of children with special health care needs (from birth to age 22) about experiences caring for their child(ren).  Your input will provide valuable information about our programs and services.

Participation in this survey is voluntary, and you may skip any questions you do not wish to answer. You may also stop participating at any time. All responses will be grouped and reported to give us information about community and family needs across Texas. In reports based on this survey, no one will be identified by name and individuals will not be linked to their answers to the questions.

The survey takes about 15-20 minutes to complete. 

If you are a young adult with special health care needs, please contact us at MCHEpi@dshs.texas.gov to request the young adult version of this survey or click here to complete it online.

If you have more than one child with special health care needs, please answer these questions once for each child with special health care needs (if you are completing a paper survey, please contact us to receive additional surveys).

If you prefer to complete this survey in Spanish, please click here.  Si prefiere completar esta encuesta en español haga clic aquí.

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* You must answer this question if you want your survey included:

Are you age 18 or older?

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* How old are you?

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* Have you already filled out this survey for another child with special health care needs?

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