For Patients & Families
Patients Community Education Survey
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indicates required field
Date
No. of children in your household
0
1
2
3
4+
No. of children with disabilities in your household
0
1
2
3
4 +
Ages of your children
0-1 yr
2-6 yrs
7-10yrs
11-14
15-18
19-21
Your zip code
Email Address
Please tell us about topics you would like to see offered to families at MCH and your most preferred way of learning that topic.
Preferred method information delivery
Please check one or more.
Topic
Workshop
Brochure
Email
CD-Rom
Workshop
Brochure
Email
CD-Rom
Workshop
Brochure
Email
CD-Rom
Workshop
Brochure
Email
CD-Rom
If a workshop is your primary education choice, please select your day and time preference.
Monday to Friday - 10:00am to Noon
Monday to Friday - 2:00pm to 4:00pm
Monday to Friday - 4:00pm to 6:00pm
Monday to Friday - 6:00pm to 8:00pm
Weekend - 10:00am to Noon
Weekend - Noon to 2:00pm
Weekend - 2:00pm to 4:00pm
Weekend - 4:00pm to 6:00pm
Please indicate your preferred location for educational programming. Please check all that apply.
Library - Indicate Location
School - Indicate Location
Miami Children's Hospital -
Indicate Location
Miami Children's Hospital, South Dade Center - Perrine, FL
Miami Children's Hospital, Dan Marino Center - Weston
Other