School-Based Health Center Interest Survey

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We are seeking multiple ways to service the continued health needs of our students. Bassett Health Clinic would be on be of those options. The Clinic would offer a comprehensive health care service to all students. The Clinic can become the main health care provider and is able to take care of all primary healthcare needs even when school is not in session. The clinic will even provide dental care.

What we need from you is the completion of the attached survey to finalize this opportunity for our students at Roxbury. The survey contains information needed by Bassett Hospital to finalize their decision on bringing the School Based Health Clinic to our school.

The survey and completion of the survey is extremely important in Roxbury School securing the critical services that can be provided by the School Based Health Clinic.

1. Are you familiar with the concept of a School-Based Health Center (SBHC)? *

Yes

Other:

2. Do you think you would enroll your child(ren) if there was a School-Based Health Center in your school? *

Yes

Other:

3. If ‘yes’, what services do you think your child(ren) might use? (check all that apply) *

a. Medical services (acute visits, chronic condition visits, well visits, immunizations)

b. Mental health services (anxiety, depression, adjustment disorders)

c. Dietary Counseling

d. Preventive dental services (cleaning, sealants, fluoride treatments

Required

4. Where does your child usually see a dentist? *

a. Within ½ hour drive

b. Greater than a ½ hour drive

c. Have not been seen recently

Required

5. Where was the last place your child had a physical examination by a health care provider outside of school? *

a. Non-Bassett Provider

b. Bassett Provider

Required

6. When your child has a medical appointment, typically how long is your child out of school? *

a. 1-2 hours

b. Half day

c. Whole day

Required

7. Has your child been seen in the Emergency Room or Urgent/Convenient Care in the last year? *

Yes

8. Does your child have an chronic condition (check all that apply) *

Asthma

Overweight/Obesity

ADHD

Anxiety/Depression

Other

None

Required

9. Does your child have health insurance? (SBHCs will see children whether or not they have insurance. *

Yes

10. Does your child’s health insurance pay for? (check all that apply) *

a. Medical services (sick visits, well visits, immunizations, chronic condition visits)___

b. Mental Health Counseling

c. Dietary Counseling

d. Preventive dental services (cleanings, sealants, fluoride treatments)

Required

Thank you for completing this survey. Please provide any additional comments or questions that you may have.

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