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Health Care Transition Guide Customer Satisfaction Survey

Customer Satisfaction Survey

Planning Your Transition from Pediatric to Adult Health Care: A Workbook to Help You Take Charge of Your Health

Please give us your honest feedback about the workbook. There are no right or wrong answers. Your name will not be on the survey. You may have someone help you answer the questions, and you do not need to answer all of the questions. Thank you for your willingness to fill out the survey!


Section One: Tell us a bit about yourself

1. Check the category or categories that describe you:
2. Check your age category: 
3.  Are you currently attending school?
4. What is the highest level of school you have completed?

Section Two:  Tell us where and why you used the workbook


5. Where did you use the workbook? (Check all the answers that apply.)
6. Which version of the workbook did you use? (Check all the answers that apply.)
7. Altogether, how much time did you spend using the workbook?
8. Why were you using the workbook? (Check all the answers that apply.)
9. Did anyone help you use the workbook?
10. If someone helped you use the workbook, check who:
11. If you are a medical professional, teacher, or other professional using the workbook in your practice, with how many students/clients/patients have you used the workbook?

Section Three:  Tell us what you thought of the workbook

12. Please rate how easy or difficult the workbook is to understand:
13. Please rate how easy or difficult the workbook is to use:
14. Did the workbook increase your knowledge of health care transition planning for young adults with disabilities?
15. Do you think what you learned from the workbook will help you in your life and/or at your job?
16. Was enough information included in the workbook?
17. Which workbook format do you prefer?
18. Overall, how satisfied were you with the workbook?

Section Four: Tell us anything else you think we ought to know

Thank you for your time and help with improving the workbook!
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