Screening Surveys

Screening Surveys for Patients & Parents

Primary Care

  1. Parent/Guardian Survey – family history, health behavior, parent & child mental health, and parents’ readiness to change
  2.  Adolescent Survey – family history, health behavior, mental health, and readiness to change

Referral Visits for Obese & Nutrition Management

  1. Nutrition Parent/Guardian Survey – family characteristics & concerns, health behavior, parent & child mental health, and readiness to change
    1. English/Spanish survey
  2. Parent/ Family Social History Form – household information and parent social history

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