U.S. Military families affected by TSC

Introduction

This 6 question survey is for active duty U.S. military personnel who have a family member with TSC who is living with them or with a relative in the U.S.

The purpose of this survey is to get an idea of the number of military families who have a family member with TSC who would consider getting consultation services with a TSC specialist who uses telehealth technology (connecting by audio and videoconferencing).

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* 1. Who in your family is in the U.S. Military?

Myself.

My spouse/partner.

Both myself and spouse/partner are.

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* 2. Is the individual who is in the military stationed in the United States?

Yes

Other (please specify)

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* 3. Who in your immediate family has TSC?

Myself.

My spouse/partner.

My child/children.

My grandchild.

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* 4. If you and/or your spouse are stationed in another country, where is your family member with TSC living?

In the United States.

In another country.

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* 5. Select all areas in which you or your family member with TSC are affected.

Behavioral or mental health issues

Epilepsy/Seizures

Kidneys

Lungs

Skin

Other (please specify)