Child Quality of Life Questionnaire Form
Please complete this form to help assess your child's day-to-day well-being and functioning. Your responses will provide valuable insights into their quality of life.
Child's Full Name
*
First Name
Last Name
Child's Age
*
In the past week, how would you rate your child's overall mood?
*
Very Unhappy
1
2
3
4
Very Happy
5
1 is Very Unhappy, 5 is Very Happy
How often did your child enjoy participating in physical activities (such as playing outside, sports, or exercise)?
*
Never
Rarely
Sometimes
Often
Always
How would you describe your child's energy level during the day?
*
Very low
Low
Average
High
Very high
How satisfied is your child with their relationships with friends or classmates?
*
Very Dissatisfied
1
2
3
4
Very Satisfied
5
1 is Very Dissatisfied, 5 is Very Satisfied
How well does your child sleep at night?
*
Very poorly
Poorly
Fairly well
Well
Very well
How much does your child enjoy going to school or childcare?
*
Not at all
A little
Somewhat
Quite a lot
Very much
How would you rate your child's ability to handle day-to-day challenges or frustrations?
*
Very Poorly
1
2
3
4
Very Well
5
1 is Very Poorly, 5 is Very Well
Please share any additional observations about your child's well-being (optional)
Submit
Should be Empty: