Heart murmur Chest Pain Fainting Palpitations/rapid heart beats Shortness of breath High blood pressure Weight Loss Fatigue Pneumonia Asthma Allergies Digestive/eating problem Eye disease/eye glasses Ear/nose/throat problem Skin problem Neurologic disorder/ Seizures ADD/ADHD Autism Spectrum Disorder Psychiatric Disorder Developmental Delays/Learning Disability Hormone problems/Diabetes Blood problem/Anemia Cancer Smoking Hospital admission or surgery Allergies to medications Does your child take any medications Has anyone in your family had the following If yes, please explain..
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