Aphasia Needs Assessment Survey
1.

I am a...

 
Consumer (person with aphasia, caregiver, etc...)
Professional
2.

What city and state do you live in?

 

 

City:
State/Province
(US/Canada):

3.

Are you male or female?

 
Male
Female
4.

Please select your age group...

 
Under 40 years old
40-60 years old
61+ years old
5.

Rate the availability of aphasia-related resources in the United States

 
Very easy to find resources Somewhat easy to find resources Somewhat difficult to find resources Very difficult to find resources        
       
  • Comment:

  • 500 characters left.
6.

Rate the availability of aphasia-related resources in your state

 
Very easy to find resources Somewhat easy to find resources Somewhat difficult to find resources Very difficult to find resources        
       
  • Comment:

  • 500 characters left.
7.

Rate the availability of aphasia-related resources in your city

 
Very easy to find resources Somewhat easy to find resources Somewhat difficult to find resources Very difficult to find resources        
       
  • Comment:

  • 500 characters left.
8.

Select all of the topics you would like to learn more about

 

 
Communication strategies for family and friends
How to keep improving after therapy ends
What to tell friends about aphasia
Coping strategies/living successfuly
Strategies for caregivers
Returning to work
Driving
Being a parent with aphasia
Legal issues such as guardianship, power of attorney, competency
Medical questions about stroke
Sexuality and intimacy
Insurance/disability payment
Starting an aphasia group/center
Aphasia advocacy
Aphasia therapy techniques
Community education/outreach
New Research
Personal experiences with aphasia
Other  
  • Comment:

  • 500 characters left.
9.

What would help you locate or utilize resources for living with aphasia?

 
 

1000 characters left.
10.

Have you ever contacted the National Aphasia Association (NAA)?

 
Yes
No
11.

Were you satisfied with the help NAA provided?

 
Yes
No
  • Comment:

  • 500 characters left.
12.

Have you ever attended a conference about aphasia?

 

 
Yes
No
  • Comment:

  • 500 characters left.
13.

 How would you like to receive information and education? (Please rank in order of preference)

 

(1 = Most preferable)
 
Attend a conference
Webinar/teleseminar (computer-based/telep-
hone-based workshop)
Receive written material
  • Comment:

  • 500 characters left.
14.

Would you be willing to pay an annual fee for access to resources?

 

 
Yes
No
15.

If you answered YES to question 14, what kind of resources would you be willing to pay for?

 

How much would you be willing to pay?

 

 
 

1000 characters left.