Education and Wellness Advocate Survey

Learning

What is your child's name?

How old is your child?

What grade is your child in?

What are your child’s academic strengths?

What are your child’s academic weaknesses?

What academic goals do you have for your child?

Health

* I understand Health Restoration is not medical advice and we do not diagnose or treat diseases. In Education and Wellness Advocacy, we connect how wellness issues impact learning outcomes to decrease stress on families and inspire parents to take aligned action

Please list your child’s most concerning health care problems at this time (in order of importance to you).

What lab testing have you done for this issue? What were the results?

Have you seen any improvement in the academic issues since getting the lab test results and implementing strategies?

What wellness and quality of life goals do you have for your child?

Is there anything I should know before our session?

EDUCATION AND WELLNESS ADVOCATE Survey

Learning

Health

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