1.Are you Male or Female?

Male

Female

2.How old are you?

3.Do you think that you would enroll your child(ren) if there was a School-Based Health Center in Margaretville Central School?

Yes

No

4.If ‘yes’, what service(s) do you think your child(ren) might use? (select all that apply)

Medical services (acute visits, chronic condition visits, well visits, immunizations)

Mental health services (anxiety, depression, adjustment disorders)

Dietary counseling

Preventative dental services (cleanings, sealants, fluoride treatments)

5.Where does your child usually see a dentist?

Within ½ hour drive

over an hour drive

Has not been seen recently

6.Where was the last place that your child had a physical examination by a health care provider outside of school?

Margaretville Community Clinic

At school by the School Doctor

Cooperstown or another Bassett site

Non Bassett provider

7.When your child has a medical appointment, typically, how long is your child out of school?

1-2 hours

half day

 the whole day

8.Has your child been seen in an Emergency Room or Urgent/Convenient Care in the last year?

Yes

No

9.Does your child have a chronic medical condition (circle all that apply)?

Asthma

Overweight/obesity

ADHD

Anxiety/depression

Other

10.Does your child have health insurance? (SBHCs will see children whether or not they have insurance?)

Yes

No

11.What would be the best way to provide you with information about a school-based health center?

Live presentation at school

Zoom presentation

School Website

School Facebook page

Direct mailing

Other

12.If you answered "other" above, please explain below.

13.Do you have any questions about a School-Based Health Center? (Please share below)