Schools’ Screening Medical History Form

This questionnaire is intended to assist in the identification of children that may experience difficulties with hearing and sight tests.
    This is a required question

    Parent's Contact Information

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    This is a required question
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    This is a required question
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    Child’s Information

    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question
    This is a required question