Pediatric clinic patient intake template editable in Google Docs, designed to capture comprehensive child health, family, and developmental information.
Enhance your clinic’s digital workflow with this Pediatric Medical Intake Form, crafted as an editable Google Doc for intuitive use in pediatric clinics, family practices, health centers, and private pediatricians.
✦ SECTIONS ✦
Patient Information
Parent(s) Information
Insurance Information
Referral Information
Current Medical Information & Primary Concern
Medications
Surgeries/Hospitalizations
Allergies
Immunizations
Pregnancy History
Delivery
Birth History
Developmental History
Review of Symptoms
Family History
Additional Info
✦ FEATURES ✦
➔Printable - just print and start writing
➔Computer/Laptop/Tablet/Phone
➔Editable Google Doc - ❗️You will need a Google Account. These templates are fully editable in Google Docs, including adding, switching, or deleting sections. No Microsoft Word or previous experience with Google Docs is needed.
➔Size - US Letter 8.5x11 & A4 8.27x11.69
REMINDER: This digital download is for personal use. If you would like to redistribute (make multiple copies) and share online, distribute as handouts for clients, groups and workshops etc., you can purchase the Redistribution License by CLICKING HERE. Purchase only ONE time and it’s good for ALL past and future purchases at CC Digital Studios Website, Etsy and TPT.
© 2023 CC Digital Studios, LLC
