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Wellness Library
Regular Checkup for a Child
Regular Checkup for a Child
Overview
Print this page and fill in the information if you are bringing your child in for an appointment.
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What questions or concerns do I have about my child that I want addressed during this appointment?
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Are there any recent stresses in the family that may be affecting my child, such as death of a loved one, loss of a job, or conflicts? Yes ___ No ___ If yes, describe briefly:
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Since the last appointment, has my child had any recent injury or been diagnosed with any new disease or condition? Yes ___ No ___ If yes, fill in the following information.
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Injury, condition, or disease
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Health professional who diagnosed the condition
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What was the prescribed treatment?
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What medicines (including prescription, over-the-counter, herbs, and natural health products) has my child taken since our last visit?
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Name of medicine
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What was the medicine for?
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Does my child have any new allergies to medicines, foods, or other substances? Yes ___ No ___ If yes, fill in the following information.
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Medicine or substance
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Reaction
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Do I have any concerns for my child in any of the following areas? If yes, describe the problem.
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Sleeping
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Eating
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Bowel or bladder
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Speech and language
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Hearing
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Vision
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How my child behaves
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Physical growth and
coordination
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Emotional state
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School or daycare
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Physical activity
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Do I need any written information or instructions about my child's care, such as growth and development changes to expect?
Reminders
- Bring your child's immunization record to the appointment. If you do not have a record, ask your doctor for one.
- Bring a list of all medicines your child is taking, or bring the medicines with you to the appointment.
- Ask about normal growth and development milestones to look for in your child.
Current as of: October 24, 2024
Author: Ignite Healthwise, LLC Staff
Clinical Review Board
All Ignite Healthwise, LLC education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.
This information does not replace the advice of a doctor. Ignite Healthwise, LLC, disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. Learn how we develop our content.
To learn more about Ignite Healthwise, LLC, visit webmdignite.com.
© 2024-2025 Ignite Healthwise, LLC.
Related Links
Follow-Up Appointment
Regular Checkup for a Lifelong Condition
Your Family Medical History
Appointment for a New Problem
First Appointment
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