Setting your location helps us to show you nearby providers and locations based on your healthcare needs.
Your Location is set to Change My Location
Cone Health wants to help you get well and stay well. This section provides tools and information to achieve good health and maintain your well-being.
Learn what community resources are available to help you get well and stay well.
View health and wellness news you can use from Cone Health providers on
View Advanced Search OptionsView All Doctors
View All Locations
Home > Patient & Family Resources > Health Library > Regular Checkup for a Child
COVID-19 Info: Vaccines | Testing | Visitor Guidelines | Stats | More
IMPORTANT NOTICE: COVID-19 testing appointments are not available at Cone Health emergency departments or urgent care locations. Click here for testing options.
Print this page and fill in the information if you are bringing your child in for an appointment.
What questions or concerns do I have about my child that I want addressed during this appointment?
Are there any recent stresses in the family that may be affecting my child, such as death of a loved one, loss of a job, or conflicts? Yes ___ No ___ If yes, describe briefly:
Since the last appointment, has my child had any recent injury or been diagnosed with any new disease or condition? Yes ___ No ___ If yes, fill in the following information.
Injury, condition, or disease
Health professional who diagnosed the condition
What was the prescribed treatment?
What medicines (including prescription, over-the-counter, herbs, and natural health products) has my child taken since our last visit?
Name of medicine
What was the medicine for?
Does my child have any new allergies to medicines, foods, or other substances? Yes ___ No ___ If yes, fill in the following information.
Medicine or substance
Do I have any concerns for my child in any of the following areas? If yes, describe the problem.
Bowel or bladder
Speech and language
How my child behaves
Physical growth and
School or daycare
Do I need any written information or instructions about my child's care, such as growth and development changes to expect?
Current as of:
February 10, 2021
Author: Healthwise StaffMedical Review: John Pope MD - PediatricsKathleen Romito MD - Family MedicineLouis Pellegrino MD - Developmental PediatricsSusan C. Kim MD - Pediatrics
Current as of: February 10, 2021
Author: Healthwise Staff
Medical Review:John Pope MD - Pediatrics & Kathleen Romito MD - Family Medicine & Louis Pellegrino MD - Developmental Pediatrics & Susan C. Kim MD - Pediatrics
To learn more about Healthwise, visit Healthwise.org.
© 1995-2021 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.
Subscribe to our Wellness Matters e-newsletter, a monthly snapshot of the some of great wellness content from Cone Health providers.