Happy Healthy Bright Kids Basic Survey

This Happy Healthy Bright Kids (HHBK) survey, can be filled by the child or the parent on the behalf of the child. This will help to diagnose the Health and Wellness (Intellectual, Emotional and Social) of the child and provide guidance and resources to help advance the child overall. Please see http://www.HHBKids.org for more info or email sanya@hhbk.com

1.Child's First and Last Name & Contact Information

2.How do you feel most of the time?

Happy

Tired

Energetic

Grumpy

3.How are your eating habits?

Regularly eat healthy breakfast, lunch, and dinner

Sometimes eat fast food

Often replace main meals with snacks

Mainly junk food and sugary drinks

5.Dental status

Brush every morning and night, and floss nightly

Brush once a day

Some cavities

Tooth ache and/or other dental issues

6.Doctor and Dentist Visits - Preventive Check-Ups

Visit dentist 2x year

Visit Doctor 1x year

Mostly sick visits

Some Emergency Room or Urgent Care Vsits

7.Academic Performance

No unexcused absences & Satisfactory grades

Some absences

Struggling in some classes

Struggling in multiple classes

8.Extracurricular Activities

Participates in school activities like music or sports

Plays with friends, siblings, and cousins regularly

Mostly plays video games or watches TV/Computer

Does not participate in extracurriculars nor engage with peers