Screen Reader Mode Icon Check SCREEN READER MODE to make this survey compatible with screen readers. Emergency Support Program Question Title * 1. How do you identify? Person with a SCI Family member of a person with a SCI Caregiver of a person with a SCI Other physical disability or visual impairment OK Question Title * 2. First and Last Name OK Question Title * 3. Email OK Question Title * 4. Phone Number OK Question Title * 5. During this time, are you safely able to meet your daily needs in the following areas: Yes, by myself Yes, with help from other people (family, friends, caregiver) Yes, with help from organizations No Does not apply to me Having enough food Having enough food Yes, by myself Having enough food Yes, with help from other people (family, friends, caregiver) Having enough food Yes, with help from organizations Having enough food No Having enough food Does not apply to me Having enough medicine Having enough medicine Yes, by myself Having enough medicine Yes, with help from other people (family, friends, caregiver) Having enough medicine Yes, with help from organizations Having enough medicine No Having enough medicine Does not apply to me Getting help from caregivers Getting help from caregivers Yes, by myself Getting help from caregivers Yes, with help from other people (family, friends, caregiver) Getting help from caregivers Yes, with help from organizations Getting help from caregivers No Getting help from caregivers Does not apply to me Service animal care Service animal care Yes, by myself Service animal care Yes, with help from other people (family, friends, caregiver) Service animal care Yes, with help from organizations Service animal care No Service animal care Does not apply to me PPE supplies (hand-sanitizer, sanitizing wipes) PPE supplies (hand-sanitizer, sanitizing wipes) Yes, by myself PPE supplies (hand-sanitizer, sanitizing wipes) Yes, with help from other people (family, friends, caregiver) PPE supplies (hand-sanitizer, sanitizing wipes) Yes, with help from organizations PPE supplies (hand-sanitizer, sanitizing wipes) No PPE supplies (hand-sanitizer, sanitizing wipes) Does not apply to me Medical supplies (urological, incontinence) Medical supplies (urological, incontinence) Yes, by myself Medical supplies (urological, incontinence) Yes, with help from other people (family, friends, caregiver) Medical supplies (urological, incontinence) Yes, with help from organizations Medical supplies (urological, incontinence) No Medical supplies (urological, incontinence) Does not apply to me OK Question Title * 6. Would you like to have access to online videos or resources about any of the following topics: Exercise Nutrition Mindfulness Virtual socializing (group meet ups) OK Question Title * 7. What would be most helpful to assist you during this time? OK Question Title * 8. Have you contacted any organizations for information or help during this time? Yes No OK Question Title * 9. What are you most worried about during the COVID-19 crisis? (check all that apply) Running out of food Running out of medicine Running out of medical supplies Not having the help you usually have Overall health and well-being Social Isoloation Other (please specify) OK Question Title * 10. Anything else you would like to share? OK DONE