4Sight Group Meeting Survey

4Sight is planning on starting a support and info exchange group for families of visually impaired kids and we want to hear from you. This group would give families like yours the opportunity to meet others going through the same challenges, share resources and coping skills, and network with people with whom you can relate.

As we plan this group, we're asking for your help so that we can make this group convenient and helpful for you. Please complete the survey below. Thank you for your input!

Your responses and personal information will be kept confidential and will only used for the purposes of this survey.



* indicates required fields 
  *Best Day/Time:  Daytime Monday - Friday
 Evening Monday - Friday
 Daytime Saturday, Sunday
 Evening Saturday, Sunday
 Anytime
  *Location:  Wills Eye Institute (840 Walnut St, Phila)
 CHOP (34th and Civic Center Blvd, Phila)
 Doesn't matter
 Other (Please clarify in comments below)
  *Is child care during the Support Group a concern?:  No. Someone else can care for my child while I attend the support group
 Yes. I won't be able to attend unless child care is provided at the support group
  *I'd like to be contacted about the 4Sight Group:  Yes
 No
  *Your Name:
  *Your Email Address:
  Other contact info or comments:

After completing the survey, please click on the SUBMIT button.
 
 
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