Amputee Coalition of America

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Attention Parents!

Please fill out this survey on the prosthetic and orthotic needs of your child.

Consumer Survey On Orthotics and Prosthetics

>> Click here to download the survey in printable PDF format.

PDF format requires that you have Acrobat Reader available FREE from Adobe.

The U.S. Department of Education, National Institute on Disability and Rehabilitation Research, will fund some research in children 's prosthetics and orthotics, mobility or assistive devices. This agency is focused on the needs of consumers! This is your opportunity to tell the government what YOU think should be designed and developed! You are the experts. Please respond to this survey today. Your input is VERY important.
What parts of the prosthesis, or orthosis, need to be improved? What would you like to see developed? Please be as specific as possible. List the most important ones first. (Example: Prosthetic foot that moves at the ankle).

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For the item you listed above, describe how it should work and look. (Example: The foot should look like a human foot and f t in a normal shoe.)

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For the item listed in the first row, describe how this change would help you/your child -how it would make it easier/better. (Example: It would help me look like other kids and make it easier to run.)

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May we call you for more information? Yes No

If Yes:
Name

Phone Number

Best time to call

Contact Information:
SSC, Rehabilitation Engineering Program, 7503 Bonita Street, Downey, CA 90242.
info@ranchorep.org

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Last updated: 09/01/2008
*This Web site is partially supported by the Center for Disease Control and Prevention (CDC). Its contents are solely the responsibility of the authors (association or center) and do not necessarily represent the official views of the CDC or the ACA.