green-pad

Mandatory Child Health Check Form


Please select the location you want to visit *
Please select the child *

Does your child or anyone in your household have a fever, cough, sore throat, shortness of breath or a new loss of taste or smell?

Yes
No
Please select the child *

Does your child or anyone in your household have a fever, cough, sore throat, shortness of breath or a new loss of taste or smell?

Yes
No
Please select the child *

Does your child or anyone in your household have a fever, cough, sore throat, shortness of breath or a new loss of taste or smell?

Yes
No
Please select the child *

Does your child or anyone in your household have a fever, cough, sore throat, shortness of breath or a new loss of taste or smell?

Yes
No
Please select the child *

Does your child or anyone in your household have a fever, cough, sore throat, shortness of breath or a new loss of taste or smell?

Yes
No

Need to log-in? Sign In

Not registered? Create an account

bottom blue image