Well Child Check Pre Visit Questionnaire

Visit Information

Please print and complete the pre-visit Well Child Care questionnaire prior to arriving for your appointment. You may want to review the parent handout below as well.

Please arrive 20 minutes before your appointment, if you are unable to complete your questionnaire.

Patients with completed questionnaire will need to check in 10 minutes prior to their scheduled appointment time.

Questionnaire by Age	Handouts by Age
Pediatric Health History Form	Newborn Handout
2 weeks	2 weeks
4 weeks	4 weeks
6 weeks to 2 months	6 weeks to 2 months
4 months	4 months
6 months	6 months
9 months	9 months
12 months	12 months
15 months	15 months
18 months	18 months
2 years	2 years
2.5 years	2.5 years
3 years	3 years
4 years	4 years
5 years	5 years
6-10 years	6-10 years
11-12 years	11-12 years
13-21 years	13-21 years