Dear Parents & Guardians: The schools of Emmet County are working with the Health Department of Northwest Michigan to assess the possible need to provide health services in schools.  This survey is entirely voluntary.  If you take this survey, your answers will help us better understand the healthcare needs of children in Emmet County.  Your responses to this survey will be kept confidential.

* 1. How many children do you have?

* 2. What school district(s) do your children attend?  (Choose all that apply)

* 3. What level school do your children attend? (Select all that apply)

* 4. If your children's school had a nurse or nurse practitioner on site, how often would your children use health care services at school?

* 5. If the following services were offered at your children's school, which ones would your children use? (Choose all that apply)

* 6. Related to your children's physical health, what do you worry about most?

* 7. Related to your children's emotional health, what do you worry about most?

* 8. Would you like health care services to be offered at your children's school(s)?

* 9. What type of health insurance do your children have?

* 10. Where do your children usually receive medical care?

* 11. Have all your children seen a doctor for a Wellness Visit or Physical in the past 12 months?

* 12. Have all your children visited a dentist in the past 12 months?

* 13. Which of the following problems have ever prevented you from taking your child to the doctor? (Choose all that apply)

* 14. How many times have you taken any of your children to the ER in the past 12 months?

* 15. If you took your child to the ER in the past 12 months, what time of day was your child in the ER?  (If multiple visits, choose all that apply)

* 16. In the past 12 months, have any of your children been admitted to the hospital following a visit to the ER?

* 17. Is there anything else you would like to share with us about your children's healthcare or school based health services?

Thank you for your feedback, we appreciate your time!

If you have students in Pellston, be sure to check out the Hornet Health Center:  http://www.nwhealth.org/mobile/hhc.html

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