Screening Questions for Bullying

Screening Questions for Bullying (I’d like to hear about how school is going...)

How many good friends do you have in school? [text]
Do you ever feel afraid to go to school? Why?
[textarea]


[select name="Q1" value="Never|Sometimes|Always"] <-- Do other kids ever bully you at school, in your neighborhood, or online? [conditional field="Q1" condition="(Q1).isNot('Never')"]
Who bullies you?
[textarea]
When and where does it happen?
[textarea]
What do they say or do?
[textarea][/conditional]


What do you do if you see other kids being bullied?
[textarea]
Who can you go to for help if you or someone you know is being bullied?
[textarea]
[checkbox memo="display/hide footnotes" name="footnotes" value=""][conditional field="footnotes" condition="(footnotes).isNot('')"]
footnotes: [link url="https://www.stopbullying.gov/resources-files/roles-for-pediatricians-tipsheet.pdf" memo="#1"] www.stopbullying.gov[/conditional]