Bright Futures Previsit Questionnaire 18 to 21 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
Vision
Hearing
Tuberculosis
Dyslipidemia
Anemia
Alcohol or Drug Use
STIs
For Females Only
Anemia
STIs
Cervical Dysplasia
Pregnancy
For Males Only
STIs
Growing and Developing