Statements	Strongly Agree	Agree	Uncertain	Disagree	Strongly Disagree
Our decision about having our child fitted with a hearing aid or being implanted with a cochlear implant was based on…
…Information received from professionals (e.g., audiologists, teachers, physicians, etc.)
…Information received from other parents with Deaf or hard of hearing children
…Information provided in literature from hearing aid or cochlear implant companies
…Information provided in government documents on hearing loss
…Other sources (__________)
Our decision about having our child fitted with a hearing aid or being implanted with a cochlear implant was also based on…
…Our concern about our child’s ability to effectively learn to use normal speech and oral language
…Our decision not to have our child become a member of a Deaf community
…Our not wanting to have to learn sign language
…Other reasons (__________)