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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