Carrollton Exempted Village Schools- School Based Clinic Services

School Based Clinic Services

This survey is designed in collaboration with Carrollton Exempted Village School District, The Carroll County General Health District, and Aultman Orville Carrollton Health Center.

Carrollton Schools is in the program planning phase for offering certain healthcare services at school, and would like your feedback as we develop the program and services. These healthcare providers consist of primary care physicians and advanced practice providers employed by Aultman Orville Carrollton Health Center. The survey should take you less than 5 minutes to complete. All responses are anonymous.

Question Title

* 1. Do you know what school based telehealth services are?

Yes, I am very familiar

Sort of, I have heard of them

No, Not familiar at all

Question Title

* 2. If your child would become sick at school how likely would you be to have your child evaluated by a healthcare provider using telehealth services (video visit with a provider) during school hours?

Yes , definately

Yes, if I did not have to miss work to pick them up

Maybe, if the circumstance where right

Maybe, if I learned more about the services

No, Do not want my child receiving health services at school

No, this is for their doctor only

Question Title

* 3. What type of health services would help you or your child the most, if provided at school? (enter as many services as you would like)

Question Title

* 4. If you answered no to participating, is there anything that could change your mind?

If my insurance was not billed for the service?

If the medications prescribed could be delivered to my home?

If the services could promise privacy?

If school personnel were not part of the visit?

If I could participate by phone or face-time?

If it was FREE

Other (please specify)

Question Title

* 5. Do you feel having healthcare services offered while at school will be helpful to your child's

	Yes, very much	Yes, somewhat	Maybe a little bit	Not at all
Learning	Learning Yes, very much	Learning Yes, somewhat	Learning Maybe a little bit	Learning Not at all	Learning
Overall Health	Overall Health Yes, very much	Overall Health Yes, somewhat	Overall Health Maybe a little bit	Overall Health Not at all	Overall Health
Attendance	Attendance Yes, very much	Attendance Yes, somewhat	Attendance Maybe a little bit	Attendance Not at all	Attendance
Sports Participation	Sports Participation Yes, very much	Sports Participation Yes, somewhat	Sports Participation Maybe a little bit	Sports Participation Not at all	Sports Participation

Question Title

* 6. Would you like to learn more about School Based Telehealth Services?

Definitely would

Probably would

Probably would not

Definitely would not