Skagit Pediatrics ONLINE Child Intake (4-15yrs)

This form is for parents to complete before the visit.

Please correct the errors described below.

We look forward to seeing you and your child.

Please complete this form and click submit. We will receive it in a safe and confidential way.

Pediatric Symptom Checklist-17 (PSC-17) (Ages 4-16) Parent

Instructions: Please mark under the heading that best fits your child.

Food Security

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