Get First Home Visit Questionnaire

Filling out the First Home Visit Questionnaire online is a vital step in ensuring a comprehensive understanding of your family's needs and dynamics. This document helps facilitate the home visit process by gathering important information about your household and child.

Follow the steps to complete the form accurately.

1. Press the ‘Get Form’ button to access the questionnaire and open it in the editing interface.
2. Begin by entering the 'Program' name and the 'Enrollment Date' at the top of the form. These details help identify your specific case.
3. In the section labeled 'Name', provide the full name of the primary caregiver. Follow this by entering their 'Birth Date'.
4. Indicate the 'Primary language' and, if applicable, the 'Secondary Language' spoken at home, as this can inform communication styles.
5. Proceed to the 'Family Information' section. Answer how many children live in your home besides the enrolled child and list their names and ages.
6. Answer the question regarding the number of adults in the home and describe their relationships.
7. Indicate if your child visits with a parent or relatives on weekends and provide comments as necessary for clarity.
8. Check the box for regular meal times and whether your family enjoys meals together at a table, and describe your meal routine.
9. Move to the 'Child Information' section. Answer whether your child has a preferred nickname, and indicate their feeding methods.
10. If applicable, describe any special feeding needs and provide a list of the child's favorite and least favorite foods.
11. Respond to questions about diapering routines and whether your child dresses themselves.
12. Detail nap routines, including times, special items your child may sleep with, and their waking times.
13. Answer questions regarding your child's social interactions and ability to follow directions, then describe their personality.
14. Complete observations related to your child’s social, emotional, cognitive, and physical skills by providing specific examples.
15. Indicate if there is a family history of developmental concerns, the types of materials available to your child, and their special interests.
16. State your hopes and dreams for your child and any prior knowledge of developmentally appropriate practices.
17. Define your goals related to the program, whether for your child, family, or personal development.
18. Finally, ensure that all parents or guardians fill in their signatures along with the date. Staff members should also sign.
19. After completing all sections, you can save changes, download, print, or share the completed form as needed.

Complete your First Home Visit Questionnaire online today to ensure a smooth home visit process.