2022 Cook Children's Community-Wide Health Assessment and Planning Survey default Caution: JavaScript execution is disabled in your browser or for this website. You may not be able to answer all questions in this survey. Please, verify your browser parameters. Introductory Questions [ idbkp ] 5100 5100 [ Q0 ] What is the primary language spoken in your household? Choose one of the following answers English Spanish Other Language No answer [ 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".] Only numbers may be entered in these fields. Child 1: Child 2: Child 3: Child 4: Child 5: Child 6: [ 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. Previous Next Resume later Please confirm you want to clear your response? Exit and clear survey Resume later Exit and clear survey ×