Parent Insights Survey
By completing this survey, you will help shape the future of a resource (Hearing Milestones) that easily fits into your day to day life! I am interested in your insights and to learn from YOU on what type of resources and tools you are seeking for you and your child. I want to hear from you on how you want to stay connected, informed, and empowered!

Below is a survey to learn from you, the parents of children with hearing loss! The survey consists of three sections of multiple choice and short answer questions relating to the following topics: Hearing Loss Resources, The School Setting, and The Effects of Hearing Loss. The entire survey should take around 15 minutes to complete.

For your time, via email, you will receive a FREE battery organizing printable to help keep your child powered up! Thanks again!

Now let's get started!!

Email address *
Please share your state or country (if outside of the U.S.) *
Your answer
Please provide the following information regarding the age(s) and general hearing loss severity for your child/children:
Mild hearing loss
Moderate hearing loss
Moderately-Severe hearing loss
Severe hearing loss
Profound hearing loss
Fluctuating hearing loss
Auditory Processing Disorder
Other or Unknown
0- 2 years
3- 4 years
5- 6 years
6- 8 years
8- 10 years
11- 14 years
15- 21 years
Next
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms