The following survey is designed for polio survivors, living in Australia, who were born from 1975 onwards.
Polio Australia is keen to identify the needs of the younger cohort of polio survivors in Australia, to allow us to provide necessary information and support.
"This younger cohort presents different needs and challenges to healthcare and rehabilitation, as well as education, social integration
and economic self-sufficiency, than their older counterparts in resource-abundant environments."¹

Your name (optional)

Your email (optional)

Your phone number

Birth year

Year you contracted polio

Which country did you contract polio in?

What suburb or area are you currently living?

I am currently:

Do you know about Polio Australia's work?

Would you like to connect with polio survivors similar age to you?

How would you like to connect with polio survivors similar age to you?
Facebook groupFacebook pageOnline forumIn-personVia telephoneOther:

Polio Australia's vision is that all polio survivors in Australia have access to appropriate health care and the support required to maintain independence and make informed lifestyle choices. The Late Effects of Polio which manifest from 15 years following the initial infection, a range of new symptoms with potentially debilitating health effects, manifesting primarily as bio-mechanical and/or neurological decline; this condition is known as the LEoP.

What information or support would you like from Polio Australia?

What resources or health professionals do you use? (Select all that apply)
NDISSpeech PathologistOrthotistDietitianPsychologist/Social WorkerExercise PhysiologistPhysiotherapistOccupational TherapistPodiatristRespiratory SpecialistMassage TherapistDisability Support (Please state which)

Do you agree to be contacted by Polio Australia to discuss your experience further?

Would you like to receive Polio Australia's newsletter and other resources?

**After they have submitted = link to Australian Polio Register and our FB Page**