16. Did the mother have any infection/ disease during pregnancy
17. Did the child cry immediately after birth
21. Was the child admitted in NICU (Neonatal Intensive Care Unit)after delivery?
22. Is Your Child Vaccinated Up to Date?
1. Abnormal (Large or small) head:
3. Frequent jerky movement of eyes:
4. Abnormal shape of ear/lips/nose/hands or legs:
6. Limp walking of your child:
7. Short length of one limb:
10. Underweight/Overweight
11. Pale, easily get tired:
14. Fits/ unconsciousness:
16. White/ brownish spots on teeth:
17. Swollen bleeding gums.
18. Itching in the night and oval spots in between fingers
19. Shortness of breath / wheezing
1. Does your child walk and run Independently?
2. Does your child able to communicate in simple sentence?
3. Does your child able to hold the pencil to draw, to scribble/ write
4. Can your child recognise a few alphabets in any of the language?
5. Does your child indicate and use the washroom Independently?
6. Do you observe any abnormalities in your child features like Limping while walking, difficult to getup from floor etc
I hereby confirm that the information I have provided about the medical condition of my child is true to the best of my knowledge.
