Parenting Experience Survey | Driscoll Health Plan

Below are a list of issues relating to being a parent. Please select the response, which best describes how you honestly feel. All data gathered is protected under the HIPPA privacy act.

* = required

Date

Which Seminar did you complete today?*

What is your participation number?*

What is your child's age today?*

What Zip Code do you live in?*

In an overall sense, how difficult has your child’s behavior been over the last 6 weeks?

To what extent do the following statements describe your experience as a parent in the last 6 weeks?*

In the last 6 weeks, how confident have you felt to undertake your responsibilities as a parent?*

How supported have you felt in your role as a parent over the last 6 weeks?*

Do you have a partner or spouse living with you or helping you raise your children?*

Yes
No

To what extent do you both agree over methods of disciplining your child?*

How supportive has your partner been towards you in your role as a parent over the last 6 weeks?*

In an overall sense, how happy do you consider your relationship with your partner to be?*

Note: the middle point, “happy” represents the degree of happiness of most relationships, please indicate the point that best describes the degree of happiness all things considered of your relationship.

Extremely unhappy
Fairly unhappy
A little unhappy
Happy
Very Happy
Extremely Happy
Perfect

	Not at all	Slightly	Moderately	Very	Extremely
Parenting is rewarding
Parenting is demanding
Parenting is stressful
Parenting is fulfilling
Parenting is depressing