Child Health Survey
  • Rate your child’s behavior according to the following aspects:
    (Not at all ) 1 - - 2 - - 3 - - 4 - - 5 (Extremely )
    Well mannered
  • In general, how healthy would you say your child is?
  • Has your child ever complained of pain or discomfort?
  • please specify
  • Has your child ever been prevented from doing physical activities due to health problems?
  • please specify
  • Has your child ever had problems with friends or family due to emotional problems or difficulties in his/her behavior?

  • please specify
  • Has your child had bodily pain or discomfort for an extended period of time?
  • please specify:
  • How well-socialized is your child?
  • How often does your child complain of fatigue?
  • In general, how well does your family get along with one another?

That's all, folks!