As required by law, our office adheres to written policies and procedures to protect the privacy of information about your child that we create, receive, or maintain. Your answers are for our records only and will be kept confidential subject to applicable laws. Please note that you will be asked some questions about your responses to this questionnaire and there may be additonal questions concerning SH 'O)ie0 WD your child’s health. This information is vital to allow us to provide appropriate care for you. This office does not use this information to discriminate.