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Health & Wellness Parent/Guardian Survey
PLEASE BE ADVISED: Survey data will remain confidential. Data will only be used for grant reporting purposes and to provide referrals to supportive services. |
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| Is your child currently enrolled in a medical insurance program? |
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| Are all household members enrolled in a medical insurance program? |
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| Has your child visited a physician in the last 12 months? |
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| Has your child visited a dentist in the last 12 months? |
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| Has your child visited an eye doctor in the last 12 months? |
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| Does your child have any physical disabilities? |
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Has your child been diagnosed with any chronic conditions/illnesses? (Example: asthma, diabetes, epilepsy; HIV/AIDS)
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| Does your child currently struggle with childhood obesity? |
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| Does your child have any allergies? |
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