Virginia Pediatric Group, Ltd. / 6 Months Checkup

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6 Months Checkup
What is your Child’s Last Name *
What is your Child’s First Name *
What is your Child's Date of Birth	/ /
How many times does your baby breastfeed per 24 hours?
Is your baby taking Vitamins?
What kind of bottled milk does your baby drink?
How many ounces (1 ounce = 30ml) of bottled milk does your baby drink per 24 hours?
What kind of solid food does your baby eat?
How often does your baby pass stool?
The Consistency of the stool is:
Where does your baby sleep?
How does your baby fall asleep?
Does your baby have problems sleeping?
Does your baby roll?
Does your baby sit?
Can your baby grasp on objects with one hand than transfer it to another?
If your baby has an object in hand then drops it to the floor, will she/he look for it as to where it went?
Will your baby make vowel sounds or squeals?
Will your baby make consonant sounds such as baba or ah goo or dada?
Will your baby turn his/her head to look at you when you are speaking?
Does your baby hear you and respond to your voice?
Where does your baby receive care?
Is your baby taking any medications regularly?
May we give your child the recommended vaccinations set forth by the AAP and the CDC?
Do you have any concerns, worries or questions? Please type in the box. (Please note that these concerns will be addressed at the check up and not before).
Comment should not be more than 110 characters.