AT Chat Co-design Expression of Interest (AT users)

Thank you for expressing your interest in being involved in AT Chat's Living Lab co-design activity.

AT Chat is collating stories from our community of AT users regarding how they believe an Assistive Technology Peer Mentor could assist them to make decisions about AT and facilitate them to reach their goals.

By completing this survey you confirm your interest in sharing your story and consent to an AT Chat team member potentially contacting you for more information.

Question Title

* 1. Please fill in your details below:

Name

Postal Code

Mobile

Question Title

* 2. Are you an assistive technology user?

Yes

Prefer not to say

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* 3. How would you describe your disability?

We are asking this question because we want to make sure we collect and understand views that reflect the diversity of disability.

Please select all that apply

Blind or low vision

Deaf or hard of hearing

Intellectual disability

Learning disability

Physical disability

Psychosocial disability or mental health condition

Prefer not to say

Other (please specify)

Question Title

* 1. Please fill in your details below:

Question Title

* 2. Are you an assistive technology user?

Question Title

* 3. How would you describe your disability?We are asking this question because we want to make sure we collect and understand views that reflect the diversity of disability. Please select all that apply

* 3. How would you describe your disability?

We are asking this question because we want to make sure we collect and understand views that reflect the diversity of disability.

Please select all that apply