Survey

Instructions

So, what do you think about this website? Don't be shy--we can handle both good and bad comments. Your responses will be used to help us to develop better programs and to reach more people.

Your individual response is completely confidential and we can't identify you from the information you provide. If you would like more information see our privacy policy and disclaimers.

Please only answer this survey one time.

Questions

1.	Is this your first visit to this website?

	Yes
	No

2.	How old are you?

3.	How did you find out about this website? (Select all that apply.)

	From another website
	At the library
	In a newspaper
	Saw a poster
	Saw materials at school
	Magazine article
	Radio spot
	TV show
	From my doctor or nurse
	From a friend
	Saw it in the Epilepsy Foundation's magazine
	Don't remember

4.	What other ways have you heard about this website?

5.	Where do you live?

6.	Tell us some more! Check out the list and tell us about you!

	I have epilepsy. Some people call it a seizure disorder.
	I think I might have it. I'm looking for answers.
	Someone I live with has it.
	Someone in my family, who I live with, has it.
	One of my friends has it.
	Someone I know, but who isn't really a friend, has it.
	No one I know has it.

7.	I consider myself an expert when it comes to information about epilepsy.

	Agree strongly
	Agree
	Disagree
	Disagree strongly
	Not sure

8.	I think kids with epilepsy deserve the same respect as everyone else.

	Agree strongly
	Agree
	Disagree
	Disagree strongly
	Not sure

9.	If someone has a seizure and I was there, I'd help.

	Agree strongly
	Agree
	Disagree
	Disagree strongly
	Not sure

10.	I'd help by putting something in their mouth.

	Agree strongly
	Agree
	Disagree
	Disagree strongly
	Not sure

11.	How would describe yourself based on the following census groups?

12.	Tell us why you visited this website.

13.	What would you have liked to see on this website that isn't here?

14.	How can we make it better?