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Epilepsy Resource Kit Feedback Survey
Purpose: We’re designing Epilepsy Resource Kits to support children and families during hospital stays, EEGs, and after a new diagnosis. Your feedback will help shape what goes inside these kits — and what information or comfort items matter most.
1.
I am a:
Parent or caregiver of a child with epilepsy
Adult living with epilepsy
Family member or friend
Healthcare professional
Other: _____________
2.
Age group of person with epilepsy (if applicable):
Infant/Toddler (0–3)
Child (4–10)
Pre-Teen (11–13)
Teen (14–17)
Adult (18+)
3.
Has your child (or you) experienced? Select all that apply
EEG monitoring (inpatient or outpatient)
Extended hospital stays
Emergency room visits for seizures
New epilepsy diagnosis
Other: _____________
4.
What items were most helpful during hospital stays or EEG testing?
5.
What items or information would you like to see included in the Epilepsy Resource Kits?
6.
What types of comfort items do you think are most important for the Epilepsy Resource Kits? Select all that apply
Activity items (coloring book, small games, puzzle, etc.)
Comfort items (stuffed animal, blanket, fidget, etc.)
Developmentally appropriate Books or magazines
Snacks
Personal care items
Other: _____________
7.
What types of items would be most helpful? (Check all that apply)
Educational materials (seizure types, triggers, device info, etc.)
Information on local epilepsy resources or support groups
Hospital tips for caregivers
Medication tracking sheets or seizure logs
Other suggestions: ______________________
8.
What’s one thing you wish you had known when your child (or you) were first diagnosed?
9.
What advice would you give to another parent or patient going through this?
10.
Any other ideas, comments, or resources you’d love to see included in the kits?