Health Needs Assessment

HTC
Hoover Intergenerational Care, Inc. Child Care Center/Preschool

Hoover Intergenerational Child Care 3216 S. Hoover Street, Los Angeles, CA 90007 TEL.: (213) 748-3700/FAX: (213) 748-0525 Web: hooverfintergenerationalchildcare.org
Parent Name Print
Special Needs
Hearing:
Child's Name & DOB
Hearing:
#2 Child's Name & DOB
Learning:
Child's Name & DOB
Learning:
#2 Child's Name & DOB
Speech:
Child's Name & DOB
Speech:
#2 Child's Name & DOB
Sight:
Child's Name & DOB
Sight:
#2 Child's Name & DOB
Behavior:
Child's Name & DOB
Behavior
#2 Child's Name & DOB
Physical Development
Child's Name & DOB
Physical Development
#2 Child's Name & DOB
SPECIAL NEEDS - Do you suspect, or does your child(ren) have difficulties with

Section 1 - - If you suspect your child(ren) may have difficulties in one of the areas, please

Would.you.like.information.or.referrals.forg

Health/Immunization Nutrition Legal Assistance

Parenting Education Family Counseling Financial Assistance/Food Stamps
Type a question

Health/ImmunizationNutritionLegal AssistanceParenting EducationFamily CounselingFinancialAssistance/Food Stamps
Other
Should be Empty:

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