Hello & Welcome from Dr. Sandra Childers
We are honored that you have given us the opportunity to help your child be as healthly as possible. We want to do what we can to help you & your family reach optimal health as soon as possible.
Please take the short time to fill out these health questionaires as thoroughly as possible. After 20+ years in practice together we have found that the more thorough we are at the begining the best chance we have to help you baby's body heal faster. Thanks again for your trust in me.
After completing each section click the "Next" button at the bottom of the page. Once completed your information with be automatically sent to our secure computer server/software. We will not share any of your confidential inforamtion with anyone or any insurance company (life or health, etc) without your expressed permission.
Yours in Health
Name of Pediatrician
Date of Last Visit
At what age, in months, was the following introduced?
At what age was your child able to (in months):
Personal Illness History