• Is this a condition that has lasted or is expected to last for at least 12 months?
• Does your child need or get special therapy such as physical, occupational, or speech therapy?
• Is this because of any medical, behavioral, or other health condition?
• Is this a condition that has lasted or is expected to last for at least 12 months?
• Does your child have any kind of emotional, developmental, or behavioral problem for which he or she needs or gets treatment or counseling?
• Has this problem lasted or is it expected to last for at least 12 months?
• What is your child's age?
• YEARS OLD
• What is your age?
• Are you male or female?
• What is the highest grade or level of school that you have completed?
• How are you related to the child?
• Did someone help you complete this survey?
• In the past 12 months, did you try to make an appointment to see a doctor or nurse?
• In the past 12 months, when you tried to make an appointment to see a doctor or nurse, how often were you able to get one as soon as you wanted?
• In the past 12 months, how often were you satisfied with the care you received during these scheduled appointments?
• Do you have a doctor or nurse who you usually see if you need a check-up, want advice about a health problem, or get sick or hurt?
• In the past 12 months, how many visits have you had with this doctor or nurse?
• In the past 12 months, how often did this doctor or nurse explain things in a way that is easy to understand?
• In the past 12 months, how often did this doctor or nurse listen carefully to you?