Family Questionnaire

The following questions are designed to help us improve services for children and youth with epilepsy and their families. This information will remain completely anonymous and be compiled with information from other Wisconsin families.

If you are uncomfortable with a question, simply skip it. If you care to elaborate on an answer from your own personal experiences, use the "Thoughts?" box included with each question. It might help to look over all of the questions before you begin.

Thank you for taking the time to help us make our state the best it can be for children and youth with epilepsy. We will not share your information.