If you are completing forms by hand, please use a PEN with BLUE or BLACK ink 2026

1. Begin by opening the form in our platform. Click ‘Get Form’ to access the editor.
2. Fill in the Patient’s Legal Name, including first name, middle initial, and last name. Ensure accuracy as this is crucial for identification.
3. Enter the Patient’s Date of Birth and Gender. Use the checkboxes provided for gender selection.
4. Complete the Patient’s Address and indicate who completed the form along with their relationship to the patient.
5. In the CURRENT CONCERNS section, check all applicable concerns regarding your child’s health or behavior.
6. Proceed to BIRTH HISTORY and provide details about birth weight, delivery method, and any complications during pregnancy.
7. Continue filling out sections on MILESTONES, MEDICAL HISTORY, SCHOOL INFORMATION, and FAMILY AND SOCIAL HISTORY as required.

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