Please select the button that corresponds to your child's age. Then print out the form, complete this form, and bring it to your child's well child check appointment. It will help us to identify your needs at each visit.
*Autism, vision, and hearing screenings have always been important components of your child's wellness checks. They are recommended by the American Academy of Pediatrics and are necessary to provide quality health care and to complete school/camp forms. Please be advised that some insurance plans no longer cover these screenings in full and you may be billed for the additional expense.*