Per the Health Care Act we are required to record your height and weight at each visit.
Please check all that apply:
What percent of the waking hours is your child in a:
Where appropriate, list your child’s age when he/she could do the following:
Please check YES or NO to the following observations and/or complaints as they relate to your child: Symptom:
Electronic Device Usage at Home and School (phone, tablet, desktop, laptop):
Members of the family who have had visual attention and why:
Has anyone in the family had:
Our goal is to provide the best, most complete, up-to-date care available. Our philosophy is preventive and developmental in approach. To provide this service in the most efficient manner, please be aware of the following office policies:
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