What is your child's chronic illness?
Diabetes Asthma Cystic Fibrosis Epilepsy Other
How long has your child been dealing with this chronic illness?
Less than 1 year 1-5 years 5-10 years More than 10 years Since birth
What challenges are you facing in managing your child's illness?
Treatment adherence Emotional support Access to specialists Financial burden Navigating school accommodations
What support systems have you utilized?
Family Friends Support groups Therapists/counselors Online communities
Are you interested in participating in research studies or clinical trials?
Yes No
All set, how can we reach you?
Name
Email
Phone
(Details here)
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