Skagit Pediatrics ONLINE Well Child Intake (4-15yrs)

This form is for parents to complete before the check-up visit.

Please correct the errors described below.

We look forward to seeing you and your child for your Well Check-up.

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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