Kids Health Questionnaire

June 13, 2011

Name of your child: ________________________________ Age: ________

Gender: _______________

Answer the following questions:

1)   How will you rate the health of your child out of 10 with 10 being the best?


2)   Does your child often suffer from cold, stomach upset or any other kind of problems?


3)   Does your child suffer from any kind  of body pain or discomfort?


4)   Please list what nutritious food your child intake during meals.

________________                          _______________                  _______________

________________                         _______________                   _______________

________________                         ________________                  _______________

5)   Does your child mainly prefer veg or non-veg?


6)   How much does your child spend on external activities daily? Mention the hours.


7)   Does your child ever suffer from any serious illness till date?


8)   Do you think your child is quite emotional and worries about things going around?


9)   Does your child interact well with his or her peers?


10)               Mention few habits of your child which are quite annoying or  the ones you dislike.


Download Kids Health Questionnaire in Word Format

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