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Well Child Care > Pre-Visit Questionnaires

Pre-Visit Questionnaires

Clipboard_stethoscope.jpgTo help get the most out of your child's well visit (physical), please print the age - appropriate questionnaire, fill it in, and bring it to your visit. (If your child isn't exactly the age listed, pick the one closest to the age.) Feel free to use the back side of the paper if you need more room.

0-2 weeks

1 month

2 months

4 months

6 months

9 months

12 months

15 months

18 months

24 month / 2 year

2 1/2 year / 30 month

3 year

4 year

5 year

6 year

7 year

8 year

9 year

10 year

11-14 years - please talk with your tween/teen and fill out together

15-17 years - please have the teen fill out their section

18-23 years - please have the young adult fill out

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