Copy of Epilepsy Alliance America- Community Needs Assessment

EAA is hoping to better understand your needs as a person with epilepsy or a caregiver. Thank you for taking this survey.

Question Title

* 1. How would you describe yourself?

Adult with Epilepsy (21 + years)

Young adult with epilepsy (under 21)

Parent or guardian of a child with epilepsy (child is under 21)

Caregiver to a person with epilepsy (spouse, partner, family member, parent of a child 21 and over, etc)

Question Title

* 2. How old are you?

13-15

16-18

18-24

25-34

35-44

45-54

55-64

65+

Prefer not to answer

Question Title

* 3. What is your race?

White or Caucasian

Black or African American

Hispanic or Latino

Asian or Asian American

American Indian or Alaska Native

Native Hawaiian or other Pacific Islander

Another race

Prefer not to answer

Copy of Epilepsy Alliance America- Community Needs Assessment

Question Title

* 1. How would you describe yourself?

Question Title

* 2. How old are you?

Question Title

* 3. What is your race?

Question Title

* 4. What is your gender?

If you prefer not answer, please move to the next question.

Question Title

* 5. What is your zip code?

If you prefer not answer, please move to the next question.

Copy of Epilepsy Alliance America- Community Needs Assessment

Question Title

* 1. How would you describe yourself?

Question Title

* 2. How old are you?

Question Title

* 3. What is your race?

Question Title

* 4. What is your gender? If you prefer not answer, please move to the next question.

Question Title

* 5. What is your zip code?If you prefer not answer, please move to the next question.

* 4. What is your gender?

If you prefer not answer, please move to the next question.

* 5. What is your zip code?

If you prefer not answer, please move to the next question.