Injury Plus SEEK Survey – 18 Months to 5 Years

Please enter information below for the child being seen today at an 18 month to 5 year visit. If the child is being seen for a birth to 12 month well-child visit, please click here. If more than one child under 5 is being seen today, please answer for the youngest child. This is voluntary. You don’t have to answer any question you prefer not to.

Being a parent is not always easy.  We want to help families have a safe environment for kids. So, we’re asking everyone these questions. They are about problems that affect many families. If there’s a problem, we’ll try to help.

  • Social Needs
  • Family Needs
  • Car Safety
  • Home Safety
 

Social Needs

1. Would you like help finding a job or employment?
 
 
2. Would you like help finding daycare for your child?
 
 
3. Do you have trouble paying utilities or maintaining a safe place to live?
 
 
4. In the past 12 months, did you worry that your food would run out before you could buy more?
 
 
5. In the past 12 months, did the food you bought just not last and you didn’t have money to get more?