Request edit access
Turner Syndrome Levels of Care Designation Survey - 2024                                                
Turner Syndrome Global Alliance (TSGA) has developed a self-reported tiered designation criteria for Turner Syndrome providers to allow families to fully understand the services available by each provider.

Please answer ALL questions in this survey to determine where your services align with the Levels of Care Designation Criteria. TSGA will use your self-assessed determination to list your Level of Care on our website listing of care providers, clinics, and centers.

This survey refers to the Turner Syndrome Levels of Care Pediatric Designation Criteria document.  A copy of this document was included in the email or you can click here to access the document.

We recommend you complete this survey as a Google Form if possible.  This survey will take approximately 6 minutes to complete.
Email *
Your Name and Title *
Connecting science, resources, and funding to the TS Community.
Hospital/Institution *
Best phone number to reach you *
These questions determine your eligibility to be listed as a LEVEL 1 TS Care Provider. *
Yes
No
My TS care program is led by Endocrinologist or Geneticist
My TS care program follows the 2017 TS Care Guidelines
We offer families information on TS Advocacy Groups as a resource. This could include a local support group, TSGA, TSSUS, or TSF.
I answered YES to questions 1-3 and believe that my program qualifies to be listed as a LEVEL 1 TS Care Provider.
These questions determine your eligibility to be listed as a LEVEL 2 TS Coordinated Care Clinic. *
Yes
No
My TS care program has a website or a link for patients to schedule.
We follow the KidNECT Care Model. To implement this model, your program must offer Networking, Education, Comprehensive Coordinated Care, and Transition support. Refer to the Designation Criteria document for more information.
We offer same day visits with multiple specialist.
I answered YES to questions 1-3 and believe that my program qualifies to be listed as a LEVEL 2 TS Coordinated Care Clinic.
These questions determine your eligibility to be listed as a LEVEL 3 TS Coordinated Care Center. *
Yes
No
We are currently collecting TS data in a REDCap database, OR we are working to implement data collection through REDCap in the next 12 months.
We offer a Transition Program for young adults that coordinates with local adult providers.
We work with our Patient/Family Advisory Council or local organized advocacy representatives to have input from families.
We coordinate access to all TS Specialty Providers (see the list of specialists on the Levels of Care document).
I answered YES to questions 1-4 and believe that my program qualifies to be listed as a LEVEL 3 TS Coordinated Care Center.
A LEVEL 4 TS Regional Resource Center provides all of the resources and services listed above in Levels 1, 2, and 3 AND is engaged in multi-institutional research.  If you feel your institution could qualify as  Level 4 Center, please respond below and TSGA will reach out to you.
Yes
No
Our TS program is engaged in multi-institutional TS research, has a TS Fellowship/Mentoring Program, and offers resources and support for regional TS Providers, Clinics, and Centers.
I am interested in learning more about designation as a TS Regional Resource Center. Please contact me.
We have identified a patient/family advocate who might be willing to work with the Clinic to represent the needs of the local TS community. *
Patient/family advocate name and contact information if available:
Please share any questions or comments you may have:
Thank you for taking the time to complete this survey.  If you have any questions, contact Liz Rowe at lrowe@TSGAlliance.org or 916-960-6224.
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This form was created inside of Turner Syndrome Global Alliance.

Does this form look suspicious? Report

Google Forms