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Parent Focus Group Screening Survey
1.
Please give basic information
Name
City/Town
State/Province
Email Address
Phone Number
2.
How old is your child with special learning or healthcare needs?
1
18
Clear
3.
Please briefly describe your child’s disability or condition.
4.
Please describe the eye care and treatment your child has received or is currently receiving.
5.
At what age did your child first receive an eye exam?
0
18
Clear
6.
Please indicate your best times for participating in our focus group.
Weekday mornings
Weekday afternoons
Weekday evenings
Weekends
Other (please specify)
Current Progress,
0 of 6 answered