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Experience of Care Parent Survey

HELP US BECOME BETTER HEALTH CARE PARTNERS: WE WANT YOUR FEEDBACK!

DIRECTIONS: For each question, please mark the response that answers the question or best describes your recent experiences. We value your honest responses. Your answers will be kept private and confidential. Thank you so much for your time!
1.When your child had their hearing screened shortly after birth, how were your baby’s results delivered to you?
2.Did your primary care provider have the results of your baby’s newborn screening in their records at your first well-baby visit?
3.From the time your baby had the screening test until the time his/her hearing loss was confirmed, how often were you able to get the help you needed for questions related to your child’s hearing loss from the health professionals listed below.
Never
Sometimes
Usually
Always
N/A
Nursery nurse
Primary Care Provider or Pediatrician
Audiologist
Ear, Nose, Throat Doctor
Early Intervention Services Coordinator
Teacher of the Deaf/Hard of Hearing
4.From the time you were told your child had a permanent hearing loss until you started early intervention services, how often were you able to get specific information on each of the following subjects?
Never
Sometimes
Usually
Always
N/A
Communication Choices
How things are paid for
Meeting other parents
Hearing Aids and/or Cochlear Implants
Use of Sign Language
Knowing where to go next in the process
Early Intervention programs
Causes of Hearing loss
5.If you would like to give us additional information on the above questions, or if there is anything else that you would like to tell us, please add your comments below. Thanks again for your time!
6.Who did you receive your Parent Resource Guide from?
7.If you would like follow up from the NE-EHDI Program, please provide your contact information below.