Are You Raising Healthy Kids?

How well do you feel you and your child are doing in terms of establishing lifelong healthy habits?

• Very well
• Average
• Not so well

Has your child had one or more routine checkup(s) this year?

• No
• Yes
• Don't know

Overall, how balanced and varied do you consider your child’s diet?

• Very balanced and varied
• Somewhat
• Not very

How often do you sit down and eat together as a family?

• Almost never, we don’t have time
• One to four nights per week
• Five or more nights per week

What is your child’s favorite pastime (pick one)?

• Video games
• Outdoor activities
• Shopping

Is your child supervised (by an adult or by software) when using the Internet?

• Yes, always
• Most of the time
• Not usually

How much sleep does your child get on most nights?

• Eight to nine hours
• Six to seven hours
• Five or less

How do you think your child would rate his/her overall self-worth or self-image?

• Very high to high
• Low to very low
• Don't know

How well does your child play with siblings and children in his/her age group?

• Well, most of the time
• Not very well
• Don't know

Does your child sit in the backseat in motor vehicles?

• Hardly Ever
• Most of the time
• Always