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1 REAPPOINTMENT INFORMATION PARENT/GUARDIAN QUESTIONNAIRE Sparkles for Special Teeth Program Date: Child's Name: Age: Date of Birth: / / Physician(s): Special Needs Diagnosis: Developmental Age: Describe

How to fill out pre-appointment information parentguardian questionnaire

How to fill out pre-appointment information parent/guardian questionnaire:

1. Start by carefully reading through the questionnaire to understand what information is being requested.
2. Gather all necessary documents or information that may be needed to complete the questionnaire, such as medical records or contact details of emergency contacts.
3. Begin by filling out the personal information section, including the child's full name, date of birth, and any other relevant details.
4. Move on to the medical history section, providing accurate and detailed information about any allergies, current medications, or previous medical conditions.
5. Fill in the emergency contact section, ensuring that all contact details are up to date and correct.
6. Answer any additional questions or sections that may be specific to your child's health or situation.
7. Double-check all the information provided to ensure accuracy and completeness.
8. If there are any sections that are not applicable, make sure to indicate that on the questionnaire.
9. Sign and date the questionnaire if required.
10. Submit the completed questionnaire to the appropriate party by the designated deadline.

Who needs pre-appointment information parent/guardian questionnaire:

1. Parents or legal guardians of children who are scheduled for medical or dental appointments.
2. Schools or organizations that require parental consent and information for field trips or extracurricular activities.
3. Childcare centers or daycare facilities that need emergency contact information and medical history for each child in their care.

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