Parent Survey

Introduction

The following questions are intended to help identify the health needs of students in our school district. This is part of a grant-funded project to increase the amount and type of health services available in our schools. We will use this information to identify providers who can meet student health needs. This survey is available in English and Spanish and it is anonymous. 

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What school district does your child/children attend? 
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1. What physical health issues or needs has your child had in the past year? Select all that apply.

2.  What social stress or social needs has your child had in the past year? Select all that apply.
3. Have you been told by a doctor that your child has any of the following ongoing health issues? Select all that apply.
4. In your opinion, what are the top 3 health concerns facing students in the school?
5. Where do you regularly take your child for health care? Select all that apply.
6. Select all reasons that have prevented you from getting medical, dental, or mental health services for your child in the last year.
7. Do you have a regular source of dental care for your child?
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8. How do you currently pay for health services for your child?
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9. The LAST TIME you took your child/children to a health care appointment did you have to miss work?
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10. The LAST TIME you took your child/children to a health care appointment did they have to miss school?
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