用眼行为调查问卷48年级学生问卷-springerstaticcontentserver.docVIP

The National Eye Care Study Questionnaire (Student Questionnaire for Grade 4-9 Children) Part One Gender ① boy； ② girl Nationality ①Han nationality ②Others Birth date Registered residence ①rural； ②urban School Filling Date Grade ①Grade 4 ②Grade 5 ③Grade 6 ④Grade 7 ⑤Grade 8 ⑥Grade 9 Part Two 1. What is the type of houing you living in? ① flat room ② 1 -3 floors ③ 4-6 floors 4 ④ 7 or more floors 2. Have you been diagnosed by a medical doctor of myopia? ① yes； ② no 3. Father’s date of birth