1. BACKGROUND INFORMATION

The TS Alliance would like to know about your experience at the TSC Clinic you/your child go to for care.   Your comments will be shared with the TSC Clinic Director and staff.   Please help us by completing this short survey, which should take you about 5 minutes to complete.  This form is anonymous--your answers will not be linked to any information that can identify you.

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* 2. Which of the following best describes you?

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* 3. In the last 12 months, how many times did you visit this TSC Clinic to get care?  This applies to yourself, a relative, or other person with TSC for whom you are their caregiver.

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* 4. Which conditions did a doctor or other healthcare professional at this TSC Clinic evaluate at this visit?

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* 5. In the last 12 months, did you phone the TSC Clinic to get an appointment for an illness, injury, or condition that needed care right away?

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