2022 Cook Children's Community-Wide Health Assessment and Planning Survey

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Introductory Questions
[ idbkp ]
[ Q0 ]
What is the primary language spoken in your household?
[ Q0x3 ]
What other language is primarily spoken in your household?
[ Q0a ]
What are the ages of all children 0-17 years old that usually live or stay at this address? [If your child is under the age of one year old, please enter "01".]
[ Note ]

To save you time, please answer the remaining survey questions for only ONE child who is 0-17 years old.

If you have MORE THAN ONE child (0-17 years old), answer for the child who celebrates their birthday next.