.

Parenting Questionnaire

Dear Sir or Madam, please take a few minutes of your time to complete the following questionnaire.

Secured
Survio
1

Does your child need to be patted to sleep?

Please select yes or no.
2

Age

Please enter the age of your child.
3

Name

Please enter the name of your child.
4

Birthday

Please enter the birthday of your child.
5

Allergies

Please mention any allergies your child has.
6

Who does your child live with?

Please provide information on the people and pets your child lives with.
7

What to know about your child to help them calm down or feel better

Please share any information that could help in calming down or making your child feel better.
8

You can...

Please fill in how you can help your child calm down or feel better.
9

My child loves

Tell us about your child's favorite toys, activities, or things.
10

My child has a difficult time when...

Please mention situations that frustrate your child.
11

Is your child potty trained?

Please select yes or no.