regular checkup for a child
overview
print this page and fill in the information if you are bringing your child in for an appointment.
what questions or concerns do i have about my child that i want addressed during this appointment? |
are there any recent stresses in the family that may be affecting my child, such as death of a loved one, loss of a job, or conflicts? yes ___ no ___ if yes, describe briefly: |
since the last appointment, has my child had any recent injury or been diagnosed with any new disease or condition? yes ___ no ___ if yes, fill in the following information.
injury, condition, or disease | health professional who diagnosed the condition | what was the prescribed treatment? |
---|---|---|
what medicines (including prescription, over-the-counter, herbs, and natural health products) has my child taken since our last visit?
name of medicine | what was the medicine for? |
---|---|
does my child have any new allergies to medicines, foods, or other substances? yes ___ no ___ if yes, fill in the following information.
medicine or substance | reaction |
---|---|
do i have any concerns for my child in any of the following areas? if yes, describe the problem.
sleeping | |
eating | |
bowel or bladder | |
speech and language | |
hearing | |
vision | |
how my child behaves | |
physical growth and coordination | |
emotional state | |
school or daycare | |
physical activity |
do i need any written information or instructions about my child's care, such as growth and development changes to expect?
reminders
- bring your child's immunization record to the appointment. if you do not have a record, ask your doctor for one.
- bring a list of all medicines your child is taking, or bring the medicines with you to the appointment.
- ask about normal growth and development milestones to look for in your child.
credits
current as of: october 24, 2023
author: healthwise staff
clinical review board
all healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.
current as of: october 24, 2023
author: healthwise staff
clinical review board
all healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.