This form builds your child's Digital Profile: when, how long, what, with whom and why your child uses screens. Honest answers matter more than "good" answers.
It is the Week 0–1 (Understand) step of the 4-week program, and becomes the baseline compared at the end of Week 4.
- Fill it for one child. Use a separate form for each child.
- Takes about 30–40 minutes. Both parents can fill it together.
- Answer based on the last 4 weeks, not the best or worst day.
- Before Section E (Calendar), observe your child for one school day and one holiday.
- If unsure, write "Not sure". Write "—" if a question does not apply.
- Your answers save automatically on this device. All information is confidential.
Sections G, I and J are screening checklists, not diagnoses.