Who lives in the same household as the child?
Add New Individual
Please select all of the following symptoms that apply to your child:
If yes, provide the needed information below:
Add New Provider
Please select any known psychiatric illnesses in blood relatives of the child:
Please list all medication your child is currently taking:
Add New Medication
(Not all parents remember the answers to these questions. You can write down what you do remember or look back if you kept a baby book.)
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