Immunizations

45 min

19.99 US dollars

Location 1

Service Description

Through this and other services, I’ve cared for numerous patients throughout my career as a Neurologist. To me, nothing matters more than your health and comfort, which is why I’ve put in so much time and effort into advancing my medical practice and techniques. Please get in touch to schedule an initial consultation.

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?