LightenUp Lancaster County has compiled a healthy habit screening sheet, which is available for download here. Below are some of the areas that are examined:

Dietary History
Typically, how many total servings of fruits and/or vegetables does your child eat each day?
A) 0 B) 1 C) 2 D) 3 E) 4 F) 5 or more

Typically, how many times per week does your child eat fast food or at restaurants?
A) 5 or more B) 4 C) 3 D) 2 E) 1 F) 0

Typically, how many times per week does your child eat breakfast?
A) 0 B) 1 C) 2 D) 3 E) 4 F) 5 or more

Typically, how many nights per week do you have a family meal at home?
A) 0 B) 1 C) 2 D) 3 E) 4 F) 5 or more

Typically, how many times a day does your child drink sweetened drinks (Tea, lemonade, soda etc)?
A) 5 or more B) 4 C) 3 D) 2 E) 1 F) 0

Typically, what type of milk does your child drink?
A) None B) Whole C) 2% D) 1% E) Skim

Typically, how many servings (4oz) of 100% juice does your child drink each day?
A) 5 or more B) 4 C) 3 D) 2 E) 1 F) 0

Activity Assessment
Typically, how many days a week does your child have 60 minutes of physical activity/active play?
A) 0 B) 1 C) 2 D) 3 E) 4 F) 5 or more

Typically, how many hours a day of screen time (TV, Computer, Video games etc) does your child have?
A) 5 or more B) 4 C) 3 D) 2 E) 1 F) 0

Where of the above would you like to make a change?

Family History
Which of the following health conditions are in your family?
(child's parents, grandparents, aunts, uncles, siblings, cousins)

• High Blood Pressure
• Obesity
• Type 2 Diabetes
• Early (<55) Heart Disease
• Early (<55) Stroke