Epilepsy Queensland

Let's begin.

Thank you for helping us to serve you better - we are seeking your feedback so we can provide a better, more valuable service to those who are affected by epilepsy. With your help we will be able to ensure that we are supporting our members in the best way possible. Thank you for your help.

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* 1. How are you impacted by epilepsy? (please check all that apply)

I have been diagnosed with epilepsy.

I have not been diagnosed with epilepsy but I have seizures.

A member of my family has been diagnosed with epilepsy

I am the parent or guardian of a child diagnosed with epilepsy.

I provide products and services to those diagnosed with epilepsy

I have a friend, colleague with epilepsy

I am the employer of a person diagnosed with epilepsy

I am the teacher/educator of a person with epilepsy

I am a disability worker

Other (please specify)

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* 2. How long have you/they been diagnosed with epilepsy?

under 12months

1-3 years

3-5 years

5-10 years

over 10 years

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* 3. At what age were you/they first diagnosed?

Baby/Toddler

Primary School aged

Secondary school aged

As a young adult aged 20 - 34

As a mature adult 35 - 54

Over 55 years of age

Other (please specify)

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* 4. What were your three main reasons for using the information or services offered by Epilepsy Qld?

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* 5. What do you believe Epilepsy Qld is doing well?

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* 6. What could Epilepsy Qld do to improve their services ?

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* 7. Please rate how easy it is to do the following with Epilepsy Queensland, using a rating of 1 to 7, where 1 is extremely difficult and 5 is extremely easy.

	1-Extremely difficult	2	3	4	5	6	7 - Extremely easy	N/A
Join as a member	Join as a member 1-Extremely difficult	Join as a member 2	Join as a member 3	Join as a member 4	Join as a member 5	Join as a member 6	Join as a member 7 - Extremely easy	Join as a member N/A
Renew your membership	Renew your membership 1-Extremely difficult	Renew your membership 2	Renew your membership 3	Renew your membership 4	Renew your membership 5	Renew your membership 6	Renew your membership 7 - Extremely easy	Renew your membership N/A
Find the information you need	Find the information you need 1-Extremely difficult	Find the information you need 2	Find the information you need 3	Find the information you need 4	Find the information you need 5	Find the information you need 6	Find the information you need 7 - Extremely easy	Find the information you need N/A
Donate to give financial support	Donate to give financial support 1-Extremely difficult	Donate to give financial support 2	Donate to give financial support 3	Donate to give financial support 4	Donate to give financial support 5	Donate to give financial support 6	Donate to give financial support 7 - Extremely easy	Donate to give financial support N/A
Volunteer	Volunteer 1-Extremely difficult	Volunteer 2	Volunteer 3	Volunteer 4	Volunteer 5	Volunteer 6	Volunteer 7 - Extremely easy	Volunteer N/A
Speak to someone who can help you	Speak to someone who can help you 1-Extremely difficult	Speak to someone who can help you 2	Speak to someone who can help you 3	Speak to someone who can help you 4	Speak to someone who can help you 5	Speak to someone who can help you 6	Speak to someone who can help you 7 - Extremely easy	Speak to someone who can help you N/A

Additional feedback:

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* 8. How likely is it that you would recommend Epilepsy Qld to a friend or colleague?

Not at all likely

Extremely likely

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* 9. Tell us what really matters to you? Epilepsy Qld understands that each of our members have different needs. Please help us understand yours. Please rate the following statements using a scale from 1 - 5. Where 1 is extremely unimportant, to 5 which is extremely important.

	1-Extremely unimportant	2	3	4	5 - Extremely important
Tell me about new treatments.	Tell me about new treatments. 1-Extremely unimportant	Tell me about new treatments. 2	Tell me about new treatments. 3	Tell me about new treatments. 4	Tell me about new treatments. 5 - Extremely important
Connect me with counselling sand support services.	Connect me with counselling sand support services. 1-Extremely unimportant	Connect me with counselling sand support services. 2	Connect me with counselling sand support services. 3	Connect me with counselling sand support services. 4	Connect me with counselling sand support services. 5 - Extremely important
Provide access to products and services	Provide access to products and services 1-Extremely unimportant	Provide access to products and services 2	Provide access to products and services 3	Provide access to products and services 4	Provide access to products and services 5 - Extremely important
Help me inform others who are not diagnosed with epilepsy so I feel understood.	Help me inform others who are not diagnosed with epilepsy so I feel understood. 1-Extremely unimportant	Help me inform others who are not diagnosed with epilepsy so I feel understood. 2	Help me inform others who are not diagnosed with epilepsy so I feel understood. 3	Help me inform others who are not diagnosed with epilepsy so I feel understood. 4	Help me inform others who are not diagnosed with epilepsy so I feel understood. 5 - Extremely important
Having someone available to talk to me and support me	Having someone available to talk to me and support me 1-Extremely unimportant	Having someone available to talk to me and support me 2	Having someone available to talk to me and support me 3	Having someone available to talk to me and support me 4	Having someone available to talk to me and support me 5 - Extremely important
Help me be more confident in social situations.	Help me be more confident in social situations. 1-Extremely unimportant	Help me be more confident in social situations. 2	Help me be more confident in social situations. 3	Help me be more confident in social situations. 4	Help me be more confident in social situations. 5 - Extremely important
Help me understand epilepsy.	Help me understand epilepsy. 1-Extremely unimportant	Help me understand epilepsy. 2	Help me understand epilepsy. 3	Help me understand epilepsy. 4	Help me understand epilepsy. 5 - Extremely important
Help me find employment.	Help me find employment. 1-Extremely unimportant	Help me find employment. 2	Help me find employment. 3	Help me find employment. 4	Help me find employment. 5 - Extremely important
Advise me about possible funding opportunities available to me.	Advise me about possible funding opportunities available to me. 1-Extremely unimportant	Advise me about possible funding opportunities available to me. 2	Advise me about possible funding opportunities available to me. 3	Advise me about possible funding opportunities available to me. 4	Advise me about possible funding opportunities available to me. 5 - Extremely important
Help me to communicate with health professionals (doctors,specialists).	Help me to communicate with health professionals (doctors,specialists). 1-Extremely unimportant	Help me to communicate with health professionals (doctors,specialists). 2	Help me to communicate with health professionals (doctors,specialists). 3	Help me to communicate with health professionals (doctors,specialists). 4	Help me to communicate with health professionals (doctors,specialists). 5 - Extremely important
Invite me to fund-raise or volunteer for Epilepsy Qld.	Invite me to fund-raise or volunteer for Epilepsy Qld. 1-Extremely unimportant	Invite me to fund-raise or volunteer for Epilepsy Qld. 2	Invite me to fund-raise or volunteer for Epilepsy Qld. 3	Invite me to fund-raise or volunteer for Epilepsy Qld. 4	Invite me to fund-raise or volunteer for Epilepsy Qld. 5 - Extremely important
Educate the wider community on epilepsy.	Educate the wider community on epilepsy. 1-Extremely unimportant	Educate the wider community on epilepsy. 2	Educate the wider community on epilepsy. 3	Educate the wider community on epilepsy. 4	Educate the wider community on epilepsy. 5 - Extremely important
Invite me to participate in research.	Invite me to participate in research. 1-Extremely unimportant	Invite me to participate in research. 2	Invite me to participate in research. 3	Invite me to participate in research. 4	Invite me to participate in research. 5 - Extremely important
Help me make my children feel more confident at school.	Help me make my children feel more confident at school. 1-Extremely unimportant	Help me make my children feel more confident at school. 2	Help me make my children feel more confident at school. 3	Help me make my children feel more confident at school. 4	Help me make my children feel more confident at school. 5 - Extremely important

Does anything else matter to you? Please add it here if it is not mentioned.

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* 10. Now that we know what is most important to you. Can you please rate the experience provided by Epilepsy Qld where 1 is extremely dissatisfied and 5 is extremely satisfied.

	1-Extremely dissatisfied	2	3	4	5 - Extremely satisfied	N/A
Help me find employment.	Help me find employment. 1-Extremely dissatisfied	Help me find employment. 2	Help me find employment. 3	Help me find employment. 4	Help me find employment. 5 - Extremely satisfied	Help me find employment. N/A
Advise me about possible funding opportunities available to me.	Advise me about possible funding opportunities available to me. 1-Extremely dissatisfied	Advise me about possible funding opportunities available to me. 2	Advise me about possible funding opportunities available to me. 3	Advise me about possible funding opportunities available to me. 4	Advise me about possible funding opportunities available to me. 5 - Extremely satisfied	Advise me about possible funding opportunities available to me. N/A
Help me understand epilepsy.	Help me understand epilepsy. 1-Extremely dissatisfied	Help me understand epilepsy. 2	Help me understand epilepsy. 3	Help me understand epilepsy. 4	Help me understand epilepsy. 5 - Extremely satisfied	Help me understand epilepsy. N/A
Provide access to products and services	Provide access to products and services 1-Extremely dissatisfied	Provide access to products and services 2	Provide access to products and services 3	Provide access to products and services 4	Provide access to products and services 5 - Extremely satisfied	Provide access to products and services N/A
Invite me to fund-raise or volunteer for Epilepsy Qld.	Invite me to fund-raise or volunteer for Epilepsy Qld. 1-Extremely dissatisfied	Invite me to fund-raise or volunteer for Epilepsy Qld. 2	Invite me to fund-raise or volunteer for Epilepsy Qld. 3	Invite me to fund-raise or volunteer for Epilepsy Qld. 4	Invite me to fund-raise or volunteer for Epilepsy Qld. 5 - Extremely satisfied	Invite me to fund-raise or volunteer for Epilepsy Qld. N/A
Tell me about new treatments.	Tell me about new treatments. 1-Extremely dissatisfied	Tell me about new treatments. 2	Tell me about new treatments. 3	Tell me about new treatments. 4	Tell me about new treatments. 5 - Extremely satisfied	Tell me about new treatments. N/A
Help me inform others who are not diagnosed with epilepsy so I feel understood.	Help me inform others who are not diagnosed with epilepsy so I feel understood. 1-Extremely dissatisfied	Help me inform others who are not diagnosed with epilepsy so I feel understood. 2	Help me inform others who are not diagnosed with epilepsy so I feel understood. 3	Help me inform others who are not diagnosed with epilepsy so I feel understood. 4	Help me inform others who are not diagnosed with epilepsy so I feel understood. 5 - Extremely satisfied	Help me inform others who are not diagnosed with epilepsy so I feel understood. N/A
Connect me with counselling sand support services, .	Connect me with counselling sand support services, . 1-Extremely dissatisfied	Connect me with counselling sand support services, . 2	Connect me with counselling sand support services, . 3	Connect me with counselling sand support services, . 4	Connect me with counselling sand support services, . 5 - Extremely satisfied	Connect me with counselling sand support services, . N/A
Having someone available to talk to me and support me	Having someone available to talk to me and support me 1-Extremely dissatisfied	Having someone available to talk to me and support me 2	Having someone available to talk to me and support me 3	Having someone available to talk to me and support me 4	Having someone available to talk to me and support me 5 - Extremely satisfied	Having someone available to talk to me and support me N/A
Invite me to participate in research.	Invite me to participate in research. 1-Extremely dissatisfied	Invite me to participate in research. 2	Invite me to participate in research. 3	Invite me to participate in research. 4	Invite me to participate in research. 5 - Extremely satisfied	Invite me to participate in research. N/A
Help me to communicate with health professionals (doctors,specialists).	Help me to communicate with health professionals (doctors,specialists). 1-Extremely dissatisfied	Help me to communicate with health professionals (doctors,specialists). 2	Help me to communicate with health professionals (doctors,specialists). 3	Help me to communicate with health professionals (doctors,specialists). 4	Help me to communicate with health professionals (doctors,specialists). 5 - Extremely satisfied	Help me to communicate with health professionals (doctors,specialists). N/A
Help me make my children feel more confident at school.	Help me make my children feel more confident at school. 1-Extremely dissatisfied	Help me make my children feel more confident at school. 2	Help me make my children feel more confident at school. 3	Help me make my children feel more confident at school. 4	Help me make my children feel more confident at school. 5 - Extremely satisfied	Help me make my children feel more confident at school. N/A
Help me be more confident in social situations.	Help me be more confident in social situations. 1-Extremely dissatisfied	Help me be more confident in social situations. 2	Help me be more confident in social situations. 3	Help me be more confident in social situations. 4	Help me be more confident in social situations. 5 - Extremely satisfied	Help me be more confident in social situations. N/A
Educate the wider community on epilepsy.	Educate the wider community on epilepsy. 1-Extremely dissatisfied	Educate the wider community on epilepsy. 2	Educate the wider community on epilepsy. 3	Educate the wider community on epilepsy. 4	Educate the wider community on epilepsy. 5 - Extremely satisfied	Educate the wider community on epilepsy. N/A

Does anything else matter to you? Please add it here if it is not mentioned.

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* 11. Epilepsy Qld has some special programs and we would like you to tell us how useful you feel they are to you?

	1- Not at all useful	2	3	4	5 -Extremely useful	N/A
Emailed newsletter	Emailed newsletter 1- Not at all useful	Emailed newsletter 2	Emailed newsletter 3	Emailed newsletter 4	Emailed newsletter 5 -Extremely useful	Emailed newsletter N/A
"The Flame"	"The Flame" 1- Not at all useful	"The Flame" 2	"The Flame" 3	"The Flame" 4	"The Flame" 5 -Extremely useful	"The Flame" N/A
Information webinars	Information webinars 1- Not at all useful	Information webinars 2	Information webinars 3	Information webinars 4	Information webinars 5 -Extremely useful	Information webinars N/A
Epilepsy Symposium	Epilepsy Symposium 1- Not at all useful	Epilepsy Symposium 2	Epilepsy Symposium 3	Epilepsy Symposium 4	Epilepsy Symposium 5 -Extremely useful	Epilepsy Symposium N/A
Little Poss program for children	Little Poss program for children 1- Not at all useful	Little Poss program for children 2	Little Poss program for children 3	Little Poss program for children 4	Little Poss program for children 5 -Extremely useful	Little Poss program for children N/A
Training on epilepsy	Training on epilepsy 1- Not at all useful	Training on epilepsy 2	Training on epilepsy 3	Training on epilepsy 4	Training on epilepsy 5 -Extremely useful	Training on epilepsy N/A
Administration of Midazolam training	Administration of Midazolam training 1- Not at all useful	Administration of Midazolam training 2	Administration of Midazolam training 3	Administration of Midazolam training 4	Administration of Midazolam training 5 -Extremely useful	Administration of Midazolam training N/A
Facebook page to educate, collaborate and share stories	Facebook page to educate, collaborate and share stories 1- Not at all useful	Facebook page to educate, collaborate and share stories 2	Facebook page to educate, collaborate and share stories 3	Facebook page to educate, collaborate and share stories 4	Facebook page to educate, collaborate and share stories 5 -Extremely useful	Facebook page to educate, collaborate and share stories N/A
Resources for teenagers	Resources for teenagers 1- Not at all useful	Resources for teenagers 2	Resources for teenagers 3	Resources for teenagers 4	Resources for teenagers 5 -Extremely useful	Resources for teenagers N/A
Online learning and training	Online learning and training 1- Not at all useful	Online learning and training 2	Online learning and training 3	Online learning and training 4	Online learning and training 5 -Extremely useful	Online learning and training N/A
Lobbying and advocacy	Lobbying and advocacy 1- Not at all useful	Lobbying and advocacy 2	Lobbying and advocacy 3	Lobbying and advocacy 4	Lobbying and advocacy 5 -Extremely useful	Lobbying and advocacy N/A

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* 12. Are you receiving services under the NDIS (National Disability Insurance Scheme)?

Yes

I have tried but I was unable to access services under NDIS

I would like to know more about how I can access services

Other (please specify)

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* 13. What would make you more likely to use the services offered by Epilepsy Qld?

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* 14. Would you be interested in a follow up call to discuss your answers further or to get some additional support?

Yes

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* 15. If you wish to ensure your details are correct, can you please confirm your contact details for us?

1. Your name

2. Your preferred contact phone number:

3. Your preferred email address:

Thank you for helping us. You will now be entered into the draw to win one of 5 prizes – Wally Lewis’ Book “out of the Shadows” and Purple merchandise packs valued at $40.

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* 1. How are you impacted by epilepsy? (please check all that apply)

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* 2. How long have you/they been diagnosed with epilepsy?

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* 3. At what age were you/they first diagnosed?

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* 4. What were your three main reasons for using the information or services offered by Epilepsy Qld?

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* 5. What do you believe Epilepsy Qld is doing well?

Question Title

* 6. What could Epilepsy Qld do to improve their services ?

Question Title

* 7. Please rate how easy it is to do the following with Epilepsy Queensland, using a rating of 1 to 7, where 1 is extremely difficult and 5 is extremely easy.

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* 8. How likely is it that you would recommend Epilepsy Qld to a friend or colleague?

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* 9. Tell us what really matters to you? Epilepsy Qld understands that each of our members have different needs. Please help us understand yours. Please rate the following statements using a scale from 1 - 5. Where 1 is extremely unimportant, to 5 which is extremely important.

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* 10. Now that we know what is most important to you. Can you please rate the experience provided by Epilepsy Qld where 1 is extremely dissatisfied and 5 is extremely satisfied.

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* 11. Epilepsy Qld has some special programs and we would like you to tell us how useful you feel they are to you?

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* 12. Are you receiving services under the NDIS (National Disability Insurance Scheme)?

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* 13. What would make you more likely to use the services offered by Epilepsy Qld?

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* 14. Would you be interested in a follow up call to discuss your answers further or to get some additional support?

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* 15. If you wish to ensure your details are correct, can you please confirm your contact details for us?

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Thank you.