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PEI Cerebral Palsy Association Provincial Survey
We would like to connect with individuals and families living with cerebral palsy in Prince Edward Island.
1.
The person answering this survey is:
A parent/caregiver of a child with cerebral palsy.
A parent/caregiver of a dependent adult with cerebral palsy.
An independent adult with cerebral palsy.
A professional working with someone with cerebral palsy.
2.
What is your age or the age of the individual diagnosed with cerebral palsy?
0-6
7-12
13-18
19-30
31+
Choose not to answer.
3.
Which county do you live in on PEI?
Kings County
Queens County
Prince County
Choose not to answer.
Other (please specify)
4.
Do you or the person with cerebral palsy use mobility devices?
Yes
No
Other (please specify)
5.
Do you or the person with cerebral palsy access respite services?
Yes
No
6.
What support services/programs do you feel are lacking on Prince Edward Island?
7.
What services/programs would you like to see organized by the PEI CP Association?
8.
Do you plan to become a member of the PEI CP Association? The membership fee is $5 per person or $10 per family.
Yes
No
9.
To sign up to be contacted by the Association about becoming a member, please provide your email address: