Emergency Care

45 min

19.99 US dollars

Location 1

Contact Details

Your child's personal details

First Name

Last name

Gender

Mobile Number

Family Details:

Mother's Name

Mother's occupation

Father's Name

Father's Occupation

How many siblings does your child have? (Name, Age, Gender)

Names of local doctors or therapist who have seen your child

Current Medications: (Name, Dose, Frequency)

What it is the main medical reason / issue for seeing Dr Kothur? When did it start?

What are your other concerns?

Birth History

Any problems in pregnancy or after birth (Type of delivery, Gestational age (Term/Preterm), Birth weight, Admission to Nursery)

Any developmental concerns?

Education

Does your child attend preschool/child care/School?

Any concerns?

School Name and Grade

Details of any learning/behavioural support at school

Immunisations up to date?

Any Allergies

Any major health related or medical problems/ hospital admissions for your child in the past:

Please list significant neurological illnesses (intellectual disability, epilepsy, autism, ADHD, mental health issues etc) or autoimmune disorders affecting parents, family members, including cousins and other distant relatives?