I am
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A youth with a chronic health condition and or disability A parent or family member of a youth with a chronic health condition and or disability Involved in the care of a youth(s) with a chronic health condition and or disability
My role
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Physician Nurse Social Worker Physiotherapist Occupational Therapist Dietician Mental Health Provider (Psychologist, Psychiatrist) Community Counsellor or Worker Teacher Other
How old are you?
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12 years old or younger 13-15 years old 16-18 years old 19-21 years old 22-24 years old 25 years old or older
The age of the youth that I am looking up the information for is
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12 years old or younger 13-15 years old 16-18 years old 19-21 years old 22-24 years old 25 years old or older
Clinic setting
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I see the doctor at a pediatric clinic (for example, BC Children's Hospital or Surrey Memorial Hospital pediatric clinic) I have graduated from the children's clinic and I go to an adult specialist I go to BOTH the pediatric clinic and an adult specialist clinic
Clinic setting
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My youth sees the doctor(s) at a pediatric clinic (for example, BC Children's Hospital or Surrey Memorial Hospital pediatric clinic) My youth has graduated from the children's clinic and goes to an adult specialist My youth goes to BOTH the pediatric clinic and an adult specialist clinic
Age of youth
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I work with youth who are under 18 years of age I work with youth who are over 18 years of age
I go to the following clinic(s)
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Allergy
Asthma
Biochemical
Cardiology
Cleft Palate
Complex Care
Complex Feeding
Complex Pain
Cystic Fibrosis
Dental
Diabetes
Endocrinology
Epilepsy
Gastroenterology
General Pediatrics
General Surgery
Hematology
Mental Health
Neuromuscular
Neurology
Neuro-oncology
Oncology
Orthopedics
Plastic Surgery
Renal / Dialysis
Rheumatology
Spinal Cord
Sunny Hill Clinics
Transplant
Urology
Youth Health
Other
My youth goes to the following clinic(s)
* must provide value
Allergy
Asthma
Biochemical
Cardiology
Cleft Palate
Complex Care
Complex Feeding
Complex Pain
Cystic Fibrosis
Dental
Diabetes
Endocrinology
Epilepsy
Gastroenterology
General Pediatrics
General Surgery
Hematology
Mental Health
Neuromuscular
Neurology
Neuro-oncology
Oncology
Orthopedics
Plastic Surgery
Renal / Dialysis
Rheumatology
Spinal Cord
Sunny Hill Clinics
Transplant
Urology
Youth Health
Other
I work with youth in the
* must provide value
Pediatric clinic setting Adult practice or clinic Rehabilitation setting Community setting Community organization Educational setting
I work with groups of youth with the following conditions
* must provide value
Allergy
Asthma
Biochemical
Cardiology
Cleft Palate
Complex Care
Complex Feeding
Complex Pain
Cystic Fibrosis
Dental
Diabetes
Endocrinology
Epilepsy
Gastroenterology
General Pediatrics
General Surgery
Hematology
Mental Health
Neuromuscular
Neurology
Neuro-oncology
Oncology
Orthopedics
Plastic Surgery
Renal / Dialysis
Rheumatology
Spinal Cord
Sunny Hill Clinics
Transplant
Urology
Youth Health
Other
The clinic(s) I go to are in
* must provide value
Abbotsford
BC Children's Hospital
Burnaby
Coquitlam
Kelowna
Nanaimo
Nelson
Prince George
Surrey
Terrace
Trail
Vancouver
Victoria
Whitehorse
Other city/town in BC
Other city/town outside of BC
The clinic(s) my youth goes to are in
* must provide value
Abbotsford
BC Children's Hospital
Burnaby
Coquitlam
Kelowna
Nanaimo
Nelson
Prince George
Surrey
Terrace
Trail
Vancouver
Victoria
Whitehorse
Other city/town in BC
Other city/town outside of BC
My work is located in
* must provide value
Abbotsford
BC Children's Hospital
Burnaby
Coquitlam
Kelowna
Nanaimo
Nelson
Prince George
Surrey
Terrace
Trail
Vancouver
Victoria
Whitehorse
Other city/town in BC
Other city/town outside of BC
How did you learn about ON TRAC?
* must provide value
My pediatric health care provider (doctor, nurse, social worker, other)
My pediatrician
My family physician
My community organization (ie Diabetes Canada)
My teacher/counsellor
I was looking for information online
Family/friends
Posters and pamphlets
Workshop or education session
How did you learn about ON TRAC?
* must provide value
My youth's pediatric health care provider (doctor, nurse, social worker, other)
My youth's pediatrician
My youth's family physician
A community organization (ie Diabetes Canada)
A teacher/counsellor
I was looking for information online
Family/friends
Posters and pamphlets
Workshop or education session
How did you learn about ON TRAC?
* must provide value
Colleague
I was looking for information online
Conference
Posters and pamphlets
Workshop or education session
I did the Youth Quiz
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Yes
No
I took the Youth Quiz that I filled out to my health care visit
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Yes
No
I did the Family Checklist
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Yes
No
I took the completed Family Checklist to my youth's health care visit
* must provide value
Yes
No
After leaving the pediatric clinic, I saw my new adult physician within
* must provide value
3 months 6 months 1 year Longer than 1 year