Wi family medical 2026

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The document is a Family Medical History Questionnaire used in Wisconsin's Circuit Court for custody cases. It requires the parent without legal custody to provide detailed medical history information about themselves and their family, which may impact the health of the children involved. The form emphasizes confidentiality and accuracy, outlining various medical conditions to be reported.

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Click ‘Get Form’ to open the Family Medical History Questionnaire in the editor.
Begin by entering the names and dates of birth for each child subject to the custody order in the designated fields.
Provide the name and address of each child's primary physician, ensuring accuracy for future medical reference.
Complete the medical history questionnaire by indicating 'Yes', 'No', or 'Not Known' for each listed medical condition. Be specific about relationships and details regarding any conditions.
If applicable, elaborate on any conditions in the comments section, detailing who is affected and any relevant diagnoses or treatments.
Finally, certify that all information is true by signing and dating the form at the bottom before submitting it.

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