Exit 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 Question Title * 1. Child's First and Last Name & Contact Information Question Title * 2. How do you feel most of the time? Happy Tired Energetic Grumpy Question Title * 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 Question Title * 4. How many hours do you sleep each night? Less than 6 hours 6-8 hours 8-10 hours 10+ hours Irregular Sleep Pattern Question Title * 5. Dental status Brush every morning and night, and floss nightly Brush once a day Some cavities Tooth ache and/or other dental issues Question Title * 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 Question Title * 7. Academic Performance No unexcused absences & Satisfactory grades Some absences Struggling in some classes Struggling in multiple classes Question Title * 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 Question Title * 9. How old are you? Up to 5 years 6-8 years 8-10 years 10-12 years 12+ years Done