Untitled Document
Untitled Document
Survey for Wyoming Parents of Children with Hearing Loss
1. How many children do you have with hearing loss?   
2. What is the age of your child(ren) with hearing loss?

   Child 1     Child 2     Child 3     Child 4 
3. Has you child(ren) ever worn hearing aids?

   Child 1     Child 2     Child 3     Child 4 
4. How many hearing aids does your child(ren) currently wear?

   Child 1     Child 2     Child 3     Child 4 
5. How much did each hearing aid cost?

   Child 1     Child 2     Child 3     Child 4 
6. What sources of funding did you use to pay for the hearing aid(s)?
     (Check all that apply)









     
7. Did you use loaner hearing aids before purchasing hearing aids?


8. Since your child(ren) was diagnosed with hearing loss, how many aids have you purchased for your child(ren)?

   Child 1     Child 2     Child 3     Child 4 
9. Did the cost of hearing aids delay your ability to get them for your child(ren)?



If 'Yes' how long? 
10. If cost were not an issue, would you have chosen a different hearing aid?


11. Does your child(ren) wear a cochlear implant? If 'yes' how many?

   Child 1     Child 2     Child 3     Child 4 

12. What sources of funding did you use to pay for the cochlear implant(s)?
     (Check all that apply)









     
13. Did the cost of a cochlear implant delay your ability to obtain one or two for your child(ren)?



If 'Yes' how long? 
14. If health insurance covered the cochlear implant(s) do they also cover the upgrades?



15. What mode of communication do(es) your child(ren) use?



16. Does/did your child(ren) receive Early Intervention Services?



17. If Early Intervention services were from a Private Provider, what sources of funding did you use to pay for the services?
     (Check all that apply)









     
18. What assistive listening devices has you child(ren) used either now or in the past?
     (Check all that apply)






19. Estimate the total you have spent on assistive listening devices for use by all of your children.    $
20. What sources of funding did you use to pay for the assistive listening device(s)?
     (Check all that apply)










     
21. If your child(ren) does NOT use assistive listening devices, is it because the devices are:



Questions 22-25 are OPTIONAL - answers to these questions are useful in passing Hearing Aid Legislation in Wyoming.
22. Please mark your approximate family income before taxes:





23. What is your ethnicity?






24. What is the primary language used in your home?




25. What is the highest level of education attained by either parent?







   Do you have any additional comments related to this survey?

   

   If you are willing to be contacted for further discussion or interested in helping with legislation, please leave your name and the best way to contact you.

   

 
 
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