Please enter information below for the child being seen today at an 18 month to 5 year visit. If the child is being seen for a birth to 12 month well-child visit, please click here. If more than one child under 5 is being seen today, please answer for the youngest child. This is voluntary. You don’t have to answer any question you prefer not to.
Being a parent is not always easy. We want to help families have a safe environment for kids. So, we’re asking everyone these questions. They are about problems that affect many families. If there’s a problem, we’ll try to help.