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Health Risk Survey

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Have you ever been told by a doctor or health care provider that your child has any of these conditions?

Asthma
Cystic Fibrosis
Prediabetes
Diabetes Type 1
Elevated Blood Lead Level
Premature Birth
Stroke
Developmental Delay
Heart Disease
Seizures
Transplant
Cancer
Eczema
Kidney Disease
Sickle Cell Disease (not trait)
ADD/ADHD
Eating Disorder
Autism
Learning Disability
Depression
Bone Growth Delay

Have you ever been told by a doctor or health care provider that you have any of these conditions? (check all that apply)

Arthritis
Asthma
COPD/Emphysema
Prediabetes
Diabetes Type 1
Diabetes Type 2
Learning Disability/ Developmental Delays
Transplant
Cancer
Heart Disease
High Cholesterol
Sickle Cell Disease (not trait)
Chronic Kidney Disease
Hepatitis
HIV
Stroke
Substance Use Disorder