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* 1. What is your relationship to the child/children enrolled in Belt Public Schools?

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* 2. What grade is your child/children currently in at Belt Public Schools? (Please select all that apply)

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* 3. Does everyone in your household have health insurance?

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* 4. Does everyone in your household have dental insurance?

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* 5. Do you have someone who you consider to be your child’s/children’s doctor or health care provider?

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* 6. What services would you like to see offered at this School-Based Health Center?

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* 7. Do you support having school-based health services at Belt School?

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* 8. True or False: The school-based services save you a trip to the doctor.

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* 9. Would you access care at the school-based health center if needed?

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* 10. If you were to access care at the school-based health center, what are the best days for you to access care? (Note: the school is not open on Fridays). (Please select all that apply.)

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* 11. If you were to access care at the school-based health center, what are the best times for you to access care? (Please select all that apply.)

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* 12. What is the best way to get communication about the School-Based Health Center to you? (Select the top two ways to communicate with you)

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* 13. How do you learn about health services in your community? (Please select all that apply.)

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* 14. Feel free to list comments on how you feel about having a school-based health service at Belt School:

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* 15. If you are interested in receiving our community newsletter, please provide your email below. *Not required.
(Your survey will remain anonymous, and your email will not be shared.)

 
 50% of survey complete.

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