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Available Forms

BF 11-14yr

Bright Futures Previsit Questionnaire 11-14 Year Visits

For us to provide you with the best possible health care, we would like to get to know you better and know how things are going for you. Our discussions with you are private. We hope you will feel free to talk openly with us about yourself and your health. Information is not shared with other people without your permission unless we are concerned that someone is in danger. Thank you for your time.

What would you like to talk about today?

We are interested in answering your questions. Please check off the boxes for the topics you would like to discuss the most today.

Questions

Dyslipidemia

Anemia

Alcohol or Drug Use

For Females Only

Anemia

Growing and Developing

* Required field