Pediatric Symptom Checklist

Pediatric Symptom Checklist

If you are a Pediatrician and offer online health service this form is for you, it lets the caretaker to fill in use this simple checklist that will enable you diagnose the kid's health. Form Preview
Pediatric Symptom Checklist-17
  • Pediatric Symptom Checklist-17

  •   Never Sometimes Often
    Please mark under the heading that best fits your child
    1. Fidgety, unable to sit still
    2. Feels sad, unhappy
    3. Daydreams too much
    4. Refuses to share
    5. Does not understand other people’s feelings
    6. Feels hopeless
    7. Has trouble concentrating
    8. Fights with other children
    9. Is down on him or herself
    10. Blames others for his or her troubles
    11. Seems to be having less fun
    12. Does not listen to rules
    13. Acts as if driven by a motor
    14. Teases others
    15. Worries a lot
    16. Takes things that do not belong to him or her
    17. Distracted easily
  • Should be Empty: