Demographics

Exit Survey

Age

Age:

Sex:

Male

Female

Other

Race:

Parents' marital status during childhood/adolescence

How many siblings do you have?

Which number of child are you? (birth order)

Do you currently or have you in the past had a sibling with a chronic illness?
*Chronic illness is being defined as "physical or mental conditions, that affect the daily functioning of individuals for longer than three months a year, or for a duration of hospitalization longer than one month" (cerebral palsy, chronic renal insufficiency, epilepsy, Down’s syndrome (and other chromosomal abnormalities), cystic fibrosis, heart conditions, cancer, juvenile arthritis, asthma, dermatitis (including severe eczema and psoriasis), leukemia and various types of anemia)

Yes

Gender of chronically ill sibling

Male

Female

N/A

Other

What number is your chronically ill sibling (birth order)?