Copy of Autism 101 modules

Feedback and Background Info for Autism 101 modules

We would like to continually improve the teaching modules for our families dealing with autism. In addition, we would also like to know a little more about you and your family so we can help connect you to resources and let the state know who is utilizing our resources. Thank you for your help, since your help will provide information that supports everyone.

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* 1. How many children do you have with a diagnosis of an autism spectrum disorder

> 2

None, just interested in learning more

We are still awaiting an official diagnosis

Other (please specify)

Question Title

* 2. How old is your most recent child diagnosed or being diagnosed with an autism spectrum disorder?

1-2 years old

2-3 years old

3-4 years old

4-5 years old

5-10 years old

10-15 years old

> 15 years old

Other (please specify)

Question Title

* 3. How old was your most recent child when they were officially diagnosed with autism?

1-2 years old

2-3 years old

3-4 years old

4-5 years old

5-10 years old

10-15 years old

> 15 years old

They have still not been diagnosed

Other (please specify)

Question Title

* 4. Would you like to know more about the Tidewater Autism Society of America (TASA)?

Yes, (please add any specific contact info at the end of the survey if you wish, or visit our website at www.tidewaterasa.org)

Other (please specify)

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* 5. What is your current zip code?

Question Title

* 6. What module did you view?

Module 1: Introduction to the Autism Society and Autism

Module 2: Safety Information

Module 3: Special Education

Module 4: Medicaid Waivers

Module 5: Resource Directory

Module 6: SSI

Other (please specify)

Question Title

* 7. On a scale of 0-100 with zero being "not helpful" and one hundred being "very helpful", please rate this module?

100

Clear

i We adjusted the number you entered based on the slider’s scale.

Question Title

* 8. Have you receive any of the following services that were covered or not covered by early intervention, special education, or insurance? (More than one answer can be marked)

Speech Therapy

Physical Therapy

Occupational Therapy

Applied Behavioral Therapy

In-home behavioral counseling

Any behavioral counseling

Augmentative Communication Device

Play therapy

Aquatic Therapy

Hippotherapy

Music Therapy

Social Skills

Social Security Income

Medicaid Waiver

Other (please specify)

Question Title

* 1. How many children do you have with a diagnosis of an autism spectrum disorder

Question Title

* 2. How old is your most recent child diagnosed or being diagnosed with an autism spectrum disorder?

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* 3. How old was your most recent child when they were officially diagnosed with autism?

Question Title

* 4. Would you like to know more about the Tidewater Autism Society of America (TASA)?

Question Title

* 5. What is your current zip code?

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* 6. What module did you view?

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* 7. On a scale of 0-100 with zero being "not helpful" and one hundred being "very helpful", please rate this module?

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* 8. Have you receive any of the following services that were covered or not covered by early intervention, special education, or insurance? (More than one answer can be marked)

Question Title

* 9. Please feel free to provide any other comments or feedback? Thanks!