Thank you for taking HFM's Community Assessment survey.

To complete this survey, you must be 18 years or older and a Michigan resident. If you would like to receive a $5 Target gift card for completing this survey please share your contact information at the end of the survey - one per household. 
 
 
Purpose: the better understand the needs of the bleeding disorders community. 
 
Goal: to improve HFM's programs and services based on the results of the survey. 
 
Identifying individual responses will not be shared with anyone outside of HFM staff, though overall results from the survey may be shared with the community.

If you have any questions regarding this survey, please contact Lisa Clothier, Outreach and Community Education Manager, at lclothier@hfmich.org or at 734-961-3512.

* 1. In what county do you reside?

* 2. Please indicate your connection to the bleeding disorder community: (please check all that apply)

* 3. What age are you?

* 4. Please check all that affect your family:

* 5. What is the severity of the Hemophilia or type of vWD that affects your family? (select all that apply)

* 6. What is the age(s) of the person(s) in your family affected with a bleeding disorder? (check all that apply)

* 7. Where do you/your family member receive treatment for your/his/her bleeding disorder?

* 8. What are the most pressing challenges that you/your family are facing as a result of the bleeding disorder diagnosis?

* 9. What do you feel are your/your family's greatest strengths?

* 10. What topics would you like included in HFM programming?

* 11. Please share your thoughts on how to improve our programming and increase attendance at programming events.

* 12. Please share any other comments that you may have that would assist us in providing enhanced programming and services.

* 13. What type of educational events do you prefer? (check all that apply)

* 14. Are you familiar with HFM's Advocacy work (i.e. Lansing Day)?

* 15. Are you experiencing any issues receiving quality health care for your bleeding disorder? (Your answers will help inform HFM's advocacy work.)

* 16. What advocacy activities/opportunities would you like to see HFM provide in addition to our annual Lansing Day? (i.e. opportunities to meet with legislators in district, policy training, etc.)

* 17. Has your child ever attended camp?  If so, please indicate which session(s).  (check all that apply)

* 18. If your child has not attended camp, please share what has stopped them from attending.

* 19. How do you like to receive communications from HFM? (check all that apply)

* 20. Do you know that HFM has an emergency financial assistance program to assist families facing crises like eviction, utility shutoff, etc.?  More information can be found on our website at www.hfmich.org/financialassistance

* 21. Are you familiar with the Delta Dental program that we do in partnership with Cascade Hemophilia Consortium?  More information can be found on our website at www.hfmich.org/deltadental

* 22. Have you heard about our academic scholarship program?  More information can be found on our website at www.hfmich.org/scholarships

* 23. Are you interested in volunteering at HFM events or on an occasional office project?  

* 24. Are you interested in serving on an HFM committee? (check all that apply) Please share your contact information at the end of the survey if you are interested in serving on a committee.

* 25. How would you like to receive information provided by our industry partners?

* 26. HFM depends on the financial support of individual community members like you to provide services, events, and programs such as camp. In what ways would you consider financially supporting the work of HFM? (check all that apply)

* 27. Are you willing to share your story about various topics related to your bleeding disorder that we could share with the community at large in Facebook posts, The Artery newsletter, or at events?

* 28. Is there anything else you would like to share with HFM?

* 29. DON'T FORGET:  If you have indicated in the survey that you would like to be contacted regarding your survey responses or to receive your $5 Target gift card, please share your information below:

By clicking DONE I certify I am a Michigan resident 18+ years of age. 

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