In order to determine the best approach for helping your child, it would help to have information about your family and your child's problems. Therefore, it is requested that the parent(s) or guardian(s) complete this questionnaire as completely as possible before the first appointment.
Don’t worry if you are unable to recall all information requested. Good guesses or general answers are acceptable. Anticipate 15-30 minutes to complete this form. There is a SAVE button at the bottom if you need to stop and come back to complete the form.
This questionnaire will be submitted electronically through a confidential HIPAA compliant portal directly to The Meridian Group and will only be seen by your child's clinician.