Family Health Survey-YoMedics

1. List in order, 1 being most important and 5 being least important, the following and the impact it has on your child’s future success?

	1	2	3	4	5
Nutrition	*List in order, 1 being most important and 5 being least important, the following and the impact it has on your child’s future success? Nutrition 1	Nutrition 2	Nutrition 3	Nutrition 4	Nutrition 5
Physical Activity	Physical Activity 1	Physical Activity 2	Physical Activity 3	Physical Activity 4	Physical Activity 5
Sleep	Sleep 1	Sleep 2	Sleep 3	Sleep 4	Sleep 5
Positive Thoughts	Positive Thoughts 1	Positive Thoughts 2	Positive Thoughts 3	Positive Thoughts 4	Positive Thoughts 5
Family Unity	Family Unity 1	Family Unity 2	Family Unity 3	Family Unity 4	Family Unity 5

2. What do you feel are the major contributors to childhood/adolescent obesity? List in order of importance, 1 being most important, 5 being least important.

	1	2	3	4	5
Parental involvement	*What do you feel are the major contributors to childhood/adolescent obesity? List in order of importance, 1 being most important, 5 being least important. Parental involvement 1	Parental involvement 2	Parental involvement 3	Parental involvement 4	Parental involvement 5
Nutrition	Nutrition 1	Nutrition 2	Nutrition 3	Nutrition 4	Nutrition 5
Physical Activity	Physical Activity 1	Physical Activity 2	Physical Activity 3	Physical Activity 4	Physical Activity 5
Loving Oneself	Loving Oneself 1	Loving Oneself 2	Loving Oneself 3	Loving Oneself 4	Loving Oneself 5
TV/Sedentary activity	TV/Sedentary activity 1	TV/Sedentary activity 2	TV/Sedentary activity 3	TV/Sedentary activity 4	TV/Sedentary activity 5

3. Do you feel that your actions and behaviors influence your child’s behavior and actions?

Do you feel that your actions and behaviors influence your child’s behavior and actions? Yes

Why?

4. Are you concerned about your child’s weight now?

Are you concerned about your child’s weight now? Yes

What is Most Concerning?

5. Do you feel that diet and nutrition affect your child’s health & well-being?

Do you feel that diet and nutrition affect your child’s health & well-being? Yes

How?

6. Do you think your child get’s enough physical activity daily? How much is that?

Do you think your child get’s enough physical activity daily? How much is that? Yes

Kind and Amount or Special Circumstances?

7. Are you concerned about your own weight and health?

Are you concerned about your own weight and health? Yes

Why?

8. How much time do you spend on the internet looking for health & nutrition information for your kids/family?

How much time do you spend on the internet looking for health & nutrition information for your kids/family? Less than one hour a month

1-2 hours a month

1-2 hours per week

More than 2 hours per week

What Types of Information?

9. Do you use other primary information sources such as books, radio, pod casts, cable news or special reports? If so, what types and can you name a few?

Do you use other primary information sources such as books, radio, pod casts, cable news or special reports? If so, what types and can you name a few?

10. What magazines do you regularly read?

What magazines do you regularly read?

Family Health Survey-YoMedics
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1. List in order, 1 being most important and 5 being least important, the following and the impact it has on your child’s future success?

2. What do you feel are the major contributors to childhood/adolescent obesity? List in order of importance, 1 being most important, 5 being least important.

3. Do you feel that your actions and behaviors influence your child’s behavior and actions?

4. Are you concerned about your child’s weight now?

5. Do you feel that diet and nutrition affect your child’s health & well-being?

6. Do you think your child get’s enough physical activity daily? How much is that?

7. Are you concerned about your own weight and health?

8. How much time do you spend on the internet looking for health & nutrition information for your kids/family?

9. Do you use other primary information sources such as books, radio, pod casts, cable news or special reports? If so, what types and can you name a few?

10. What magazines do you regularly read?

Family Health Survey-YoMedicsExit this survey

1. Default Section

1. List in order, 1 being most important and 5 being least important, the following and the impact it has on your child’s future success?

2. What do you feel are the major contributors to childhood/adolescent obesity? List in order of importance, 1 being most important, 5 being least important.

3. Do you feel that your actions and behaviors influence your child’s behavior and actions?

4. Are you concerned about your child’s weight now?

5. Do you feel that diet and nutrition affect your child’s health & well-being?

6. Do you think your child get’s enough physical activity daily? How much is that?

7. Are you concerned about your own weight and health?

8. How much time do you spend on the internet looking for health & nutrition information for your kids/family?

9. Do you use other primary information sources such as books, radio, pod casts, cable news or special reports? If so, what types and can you name a few?

10. What magazines do you regularly read?

Family Health Survey-YoMedics
Exit this survey