Saint Martin de Porres High School Health and Wellness Needs Assessment
The purpose of this survey is to assess and gather information on parental needs to better identify and provide additional health support services for you and your students here at school.
Email *
Your Student/Child's Name and Grade *
Size of Family *
What healthy activities do you and your family take advantage of? *
Required
Which health concerns affect the youth in your community? *
Required
Which social/environmental concerns affect the youth in your community? *
Required
What challenges do you face in obtaining health care in your community? *
Required
Where does your student go to address health problems or concerns *
Required
Please answer the following questions regarding an in-school health & wrap around service clinic:
Do you think it's a good idea to have an in-school health and wellness clinic? *
What concerns do you have about offering an in-school clinic at Saint Martin de Porres High School? *
What health care services do you think should be offered at the in-school clinic for students? *
Required
Would you allow your child to use the in-school clinic? *
What hours would be most helpful for a clinic at the high school to you? *
Required
What health care concerns do you think should be covered? *
Required
What mental/emotional health concerns do you think should be covered? *
Required
What is your race & ethnicity? *
Required
What is your household income? *
Would you also consider using the in-school clinic for yourself and/or other children? *
What type of health insurance do you and your family have? *
How are you involved with Saint Martin de Porres High School *
Where do you usually receive primary care medical/health services for your family? *
Required
I would like to give more feedback or participate in a parent/community focus group *
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