Well Child Visit Questionnaire: Fill & Download for Free

Yes, our pediatrician’s office routinely asks if there are firearms in our home within our children’s well-visit questionnaires. They also ask if we have pets, if anyone in the home smokes and where the children primarily reside. These questions are legal, as noted in the article linked in the next paragraph.The reason they do this is that whether we like it or not, firearms are a potential health hazard - isn’t that why people own them in the first place? To ward off the health hazard of others who (ill-intentioned) may also own firearms or another weapon?If you have a firearm in the home, your pediatrician will probably go over some safety guidelines with you, like making sure the gun is stored properly, just as they would go over precautions to take if you smoke (like not smoking in the home or near your children). Yes, it’s your legal right to smoke, to own pets, to live with family in a mansion or travel in an RV, and yes, it’s legal to own firearms - but it’s also the job of your pediatrician to go over safety measures in all aspects of your child’s life.Your pediatrician has no intention of having the guns removed from your home or reporting you for owning them. One of my siblings is in law enforcement and, by the very nature of their job, has guns in the home, but it’s not an issue to the pediatrician as long as they’re storing them responsibly.

After my third child was born I went in to my OB/GYN for a planned follow up postpartum well visit.The nurse did all the preliminary chat and took weight, height and blood pressure. Nurse also handed me a form to complete.The form was a sort of standard postpartum questionnaire that would alert the physician of any red flags associated with postpartum depression.The nurse took my completed form with her and said she’d give it to the doctor that would be in to chat with me and check me out in a bit.This is the part where I take out my book and can probably get some good reading time in because let’s be honest, that doctor is probably in with a patient that’s two appointment slots ahead of me so she still has someone else to see after that before she gets to the room I’m cozied up in.She arrived within two minutes. It turns out the nurse goes through the questionnaire responses. Essentially grades my survey. The questions/answers are in the 1: completely disagree 5: completely agree format.My score was off the charts.Red flags everywhere.I didn’t “feel” depressed in any way. I wasn’t the happiest person in the world but I thought I was fine. My baby knew how to latch on to the boob really well. My ex was off with his new soul mate but that prompted all my people to double down on offering help so I had lots of support. Baby slept, I slept.Actually, I slept a lot. I remember her probing about the amount of sleep I was getting. It was a lot. My toddler son took afternoon naps like a champ, I’d get in bed at that time too, the new baby in her crib nearby and if she woke up, I’d get her into bed with me and nurse her back to sleep.My doctor did not hear a wonderful story of motherhood. She saw red flags everywhere.My doctor was lovely. Relatable and smart so I trusted her opinion.She explained the red flags the questionnaire raised and asked follow up questions. Those pushed me to the edge I didn’t know I was near. I cried. So much crying.She strongly suggested I get to the ER immediately. She would call and alert them of my arrival. There, I could see an expert that will further diagnose me and help me start a treatment plan for what appears to be severe post partum depression.She said if I didn’t go, it was my choice, but she would be obligated to have a social service agency conduct a well check on my new baby in the next day or so.I went to the ER as she suggested, not to avoid social services, but because I trusted she was right about her preliminary diagnosis and I would want to get the right help as quickly as possible.I did ok. All the little humans I was responsible for back then are still alive and well today. Medication was suggested but as a nursing mom I didn’t want to take a chance in ingesting that stuff. I became more active and enlisted friends to keep me accountable for eating well and getting some exercise and sun.I don’t know what not heeding her advice would have resulted in but the slight look of fear I saw in her eyes when she entered the examination room with my questionnaire in hand tells me I don’t want to know.

We adopted in the US via domestic infant adoption. We filled out a questionnaire stating what situations we were open to (race, gender, future birth family involvement, health history, etc). Whenever an expecting mom considering adoption contacted the agency, she would provide them with a list of what she was looking for in an adoptive family. If we met her requirements, then she was shown our profile, which is basically a scrapbook of your life and what a child’s life would be like in your family. Once she chose us as her top pick, the agency contacted us and gave us an overview of her situation. Then it was up to us to decide whether or not we wanted to meet her.During the three years we were a waiting prospective adoptive family, we met four expecting moms and emailed with two more. After meeting each of the four women for lunch, we had to decide whether we wanted to match with them and move forward with the plan being we would adopt the child once he/she was born if the birth family still wanted to place their child with us. The first woman we met and matched with changed her mind about the time she had her baby. The second woman we met didn’t seem completely decided on adoption so we decided not to match at that time. I believe she probably chose to parent. The third woman we met seemed like the perfect match to our family, but she chose a family that lived closer so she could have more frequent contact with her child.When we met the fourth woman, we didn’t think the meeting had gone well. She had some pretty serious questions that I felt like I fumbled answers to. However, she really liked us and wanted to move forward and we agreed. Over the next two months, we had lunch and visited with her every couple weeks. It was a good chance to get to know each other better. We also used that time to come up with a name together. She allowed us to attend doctor appointments, and she allowed me to be in the delivery room. Then we spent two weeks living in the NICU, where we continued to visit with our son’s birth mom, and she got to know us even better but also what kind of parents we were and how much we loved our son.In the end, we didn’t pick our child as much as his mom chose us.