Subjective Assessment sheet

Date:

Name:

Age: Gender: Male/ Female

Address:

School: Standard and medium of education:

Father’s education: Mother’ education:

Father’s occupation: Mother’s occupation:

Number of Siblings: Type of family: Joint/ nuclear

Height: Weight:

BMI:

Any existing medical condition: Yes / No (if yes which: )

Any history of recent trauma: Yes / No (if yes where: )

Any diagnosed neurological or psychological disorders: Yes / No (if yes which: )

Any diagnosed cardiovascular or respiratory disorders: Yes / No (if yes which: )

Physical fitness assessment

Cardio Pulmonary fitness:

Upper limb muscle strength:

Lower limb muscle strength:

Balance test:

Flexibility test:
 Academic Achievements

Name of the school:

Standard:

Medium of the study:

Sr. No. Subject name Total marks Obtained marks

1
2
3
4
5

Screen Time

1. Screen Time Habits:

 How many hours per day do you typically spend using screens (e.g., TV, computer,
tablet, smart phone, video games)?

 ______ hours on weekdays

 ______ hours on weekends

 ______Total hours per week

2. Types of Screen Activities:

 What are your favorite screen activities? (e.g., watching videos, playing games,
chatting with friends)

____________________________

 List the specific apps or websites you use regularly:____________________

3. Favorite screen time activities:

 What is your absolute favorite thing to do on screens?____________________

Health Related Quality of Life

1. Parent report for children score_____________________

2. Child report score____________________
3. Total score __________________