This anonymous survey is designed to gauge the needs of youth with disabilities and complex medical needs in Southwest Saskatchewan, including Swift Current and surrounding area. A local group of advocates have teamed up with several Saskatchewan based organizations to assess the gaps in services in the Southwest and establish potential solutions that are inclusive for all.  It is our hope that this survey will provide data to increase future programs and services locally.

*Please fill out one survey per individual experiencing disability

If you have questions, comments or concerns, please contact Andrea Orr at 306-491-7560 or email at a.orr@hotmail.com

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* 1. What is the age of the person experiencing disability?

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* 2. What part of the southwest do they live in or closest to?

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* 3. Please indicate your relationship to the individual

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* 4. What funding is currently received? (Please check all that apply)

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* 5. What are the current needs of the individual? (Please check all that apply)

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* 6. If this individual is in school or daycare, what level of support are they currently receiving?

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* 7. In comparison to what this individual receives in daycare or school now, what level of support do you feel they could benefit from?

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* 8. What services do you currently utilize? (Please check all that apply)

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* 9. What services would you utilize if they were available in the community? (Please check all that apply)

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* 10. What care services do you currently utilize? (Please check all that apply)

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* 11. What care services would you utilize if they were available in the community? (Please check all that apply)

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* 12. If you had access to respite services and programs, how often would you utilize them?

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* 13. Approximately how long would you require each respite service to be?

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* 14. What setting would you prefer the respite care take place? (Please check all that apply)

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* 15. What are your goals for programming in the community? (Please check all that apply)

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* 16. Which of the following healthcare services are you accessing? (Please check all that apply)*If you are accessing these services outside of the community please indicate below 

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* 17. If more readily available in the community, which of the following services would you access? (Please check all that apply)

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* 18. Please provide any additional feedback and/or comments that you feel are vital to the growth, care and support of people experiencing disability and their families in our community.

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* 19. If you would like to learn about the survey results and receive updates, please provide your information below.

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