1.Who are you?

Parent / Carer

Therapist

Educator / Support Worker

Individual with lived experience

Other (please specify)

2.What milestone or goal would you like to see as a patch?

3.Which area does this milestone relate to?

Communication

Emotional Regulation

Sensory Regulation

Gross Motor Skills

Fine Motor Skills

Daily Living

Social Skills

Community Participation

Other (please specify)

4.Why is this milestone meaningful?

5.How could this milestone be represented as a simple symbol?

6.Would you personally purchase this patch if it became available?

Yes

Maybe

No

7.Would you be interested in pre-ordering this patch to help bring it to life?

Yes

Maybe

No

8.If 5+ people pre-order this patch, it will go into production. As a thank you, your patch will be free. Does this interest you?

Yes

Maybe

No

9.Would you like to be notified if this patch goes into production?

Yes (enter email below)

No

10.Who would this patch be for?

Child

Teen

Adult

All ages