Child's Health History Checklist
The answer to these questions will help us to know if your child has any medical problems. We need this information in case he/she would become ill and we would be unable to reach you right away. Please check the right answer. We will go over the checklist with you when you have finished.
Pregnancy and Birth
Parent's Name *
Child's Name *
Were there any problems with pregnacy or your child's birth? *
Was his/her birth weight under 5 1/2 pounds? *
Did the baby have any problems in the hospital? *
Next
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy