TSC Clinic Patient and Family Experience of Care Survey (VERSION 10.29.2020)

1. BACKGROUND INFORMATION

The TSC Alliance would like to know about your experience at the TSC Clinic you or your child go to for care. Please help us by completing this short survey, which should take you about 10 minutes to complete. Your comments will be shared with the TSC Clinic Director and staff so that they can make care better. This form is anonymous--your answers will not be linked to any information that can identify you.

Question Title

* 1. First please tell us which TSC Clinic you will be telling us about in this survey.
Note: Some locations have more than one TSC Clinic so please be careful to choose the clinic that you visit.

Question Title

* 2. Which of the following best describes you? (Mark all that apply.)

I am an adult with TSC.

I am a parent or legal guardian of a child or adult with TSC.

I am a relative or caregiver but not a parent or legal guardian of a child or adult with TSC.

Other, please specify below.

Please describe yourself here if none of the above apply.

Question Title

* 3. How many family members are seen at this clinic?

One

Two

3 or more

Question Title

* 1. First please tell us which TSC Clinic you will be telling us about in this survey. Note: Some locations have more than one TSC Clinic so please be careful to choose the clinic that you visit.

Question Title

* 2. Which of the following best describes you? (Mark all that apply.)

Question Title

* 3. How many family members are seen at this clinic?

* 1. First please tell us which TSC Clinic you will be telling us about in this survey.
Note: Some locations have more than one TSC Clinic so please be careful to choose the clinic that you visit.