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Common Household Remedies and Medicines
                                               Parent Survey
                      Name: ______________________             Block: ________

                Please ask your parents to complete the following survey.DUE NEXT LESSON.
Question 1
For each statement circle a number 1-5 which indicates whether you strongly agree (5), agree (4), no
opinion (3), disagree (2) or strongly disagree (1).

1. We use medications regularly                            1      2      3       4    5

2. We prefer to use preventative health care               1      2      3       4    5

3. We regularly take multivitamins                         1      2      3       4    5

4. We use herbal/natural remedies for illnesses            1      2      3       4    5

Question 2
What is the most commonly used medication for your family? __________________________

Question 3
Please rank the most common illness to the least common illness in your house9 =most common, 1= least
common. You can give several illnesses the same rank if they are the same importance.
                        Ailment      Please rank the following items
               Headache
               Cold/Flu
               Fever
               Stomach Ache
               Toothache
               Rash
               Sore Throat
               Eye Irritation
               Earache

Question 4
Please rank the most common treatment to the least common treatment used in your house. 6 =most
common, 1= least common. You can give several treatments the same rank if they are the same
importance.
                 Treatment             Please rank the following items
                 Bed Rest
                 Multivitamins
                 Antibiotics
                 Liquids
                 Nutrition
                 Medicines (OTC)
                 Other

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Medicines parent survey

  • 1. Common Household Remedies and Medicines Parent Survey Name: ______________________ Block: ________ Please ask your parents to complete the following survey.DUE NEXT LESSON. Question 1 For each statement circle a number 1-5 which indicates whether you strongly agree (5), agree (4), no opinion (3), disagree (2) or strongly disagree (1). 1. We use medications regularly 1 2 3 4 5 2. We prefer to use preventative health care 1 2 3 4 5 3. We regularly take multivitamins 1 2 3 4 5 4. We use herbal/natural remedies for illnesses 1 2 3 4 5 Question 2 What is the most commonly used medication for your family? __________________________ Question 3 Please rank the most common illness to the least common illness in your house9 =most common, 1= least common. You can give several illnesses the same rank if they are the same importance. Ailment Please rank the following items Headache Cold/Flu Fever Stomach Ache Toothache Rash Sore Throat Eye Irritation Earache Question 4 Please rank the most common treatment to the least common treatment used in your house. 6 =most common, 1= least common. You can give several treatments the same rank if they are the same importance. Treatment Please rank the following items Bed Rest Multivitamins Antibiotics Liquids Nutrition Medicines (OTC) Other