Kerry's Place Toronto Community Services Individual and Family Survey

Introduction

At Kerry's Place we feel the input of those we support is most critical in determining the development of services. As such we are requesting that you take a few minutes to provide us with some valuable information about what sorts of services you require. The survey should take between 2 to 5 minutes to complete. If you wish further information or wish to discuss these questions over the phone please contact Gail Jones at 905-293-9788 ext. 313
Thank you.

Question Title

* 1. Are you....

An individual with a diagnosis of ASD

A family member of a child under the age of 18 with a diagnosis of ASD

A family member of an individual over the age of 18 with a diagnosis of ASD

Question Title

* 2. Please indicate the age of the individual who has a diagnosis of ASD. If there is more than one person in your family with an ASD diagnosis please indicate all that apply.

0 - 5 years old

6 - 12 years old

13 - 17 years old

18 - 21 years old

over 21 years old

Question Title

* 3. What geographical area do you currently live in?

Downtown Toronto

Etobicoke

North York

Scarborough

Other (please specify)