{"id":43,"date":"2021-12-10T11:27:16","date_gmt":"2021-12-10T11:27:16","guid":{"rendered":"https:\/\/cookevillepediatrics.com\/?page_id=43"},"modified":"2026-02-23T18:40:22","modified_gmt":"2026-02-23T18:40:22","slug":"patient-forms","status":"publish","type":"page","link":"https:\/\/cookevillepediatrics.com\/?page_id=43","title":{"rendered":"Patient Forms"},"content":{"rendered":"

[et_pb_section fb_built=”1″ module_class=”bg-overlay” _builder_version=”4.16″ _module_preset=”default” background_image=”https:\/\/cookevillepediatrics.com\/wp-content\/uploads\/2021\/12\/header-bg.jpg” global_colors_info=”{}”][et_pb_row _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][et_pb_text _builder_version=”4.16″ _module_preset=”default” header_font=”Poppins|700|||||||” header_text_color=”#FFFFFF” header_font_size=”60px” global_colors_info=”{}”]<\/p>\n

Patient forms<\/h1>\n

[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=”1″ custom_padding_last_edited=”on|phone” _builder_version=”4.16″ _module_preset=”default” custom_padding=”50px||50px||true|false” custom_padding_tablet=”50px||50px||true|false” custom_padding_phone=”50px||20px||false|false” global_colors_info=”{}”][et_pb_row column_structure=”1_2,1_2″ make_equal=”on” _builder_version=”4.16″ _module_preset=”default” custom_padding=”0px||0px||false|false” global_colors_info=”{}”][et_pb_column type=”1_2″ _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][et_pb_text _builder_version=”4.16″ _module_preset=”default” header_2_font=”Poppins|700|||||||” header_2_text_align=”left” header_2_text_color=”#333333″ header_2_font_size=”30px” custom_margin=”||10px||false|false” global_colors_info=”{}”]<\/p>\n

Patient Forms<\/h2>\n

[\/et_pb_text][et_pb_text _builder_version=”4.16″ _module_preset=”default” text_font=”Poppins||||||||” text_text_color=”#666666″ text_line_height=”26px” global_colors_info=”{}”]<\/p>\n

Welcome to the forms section. This section is provided to you as an online courtesy for printing required forms for your office visit. Please feel free to print the necessary forms and bring them with you to shorten your wait time.<\/p>\n

[\/et_pb_text][et_pb_blurb title=”Records Release” image=”https:\/\/cookevillepediatrics.com\/wp-content\/uploads\/2021\/12\/record-release.png” icon_placement=”left” image_icon_width=”60px” _builder_version=”4.17.4″ _module_preset=”default” header_font=”Poppins|600|||||||” header_text_color=”#333333″ header_font_size=”16px” body_font=”Poppins||||||||” body_text_color=”#666666″ body_font_size=”15px” body_line_height=”21px” background_color=”#FFFFFF” custom_padding=”25px|15px|25px|15px|true|true” link_option_url=”https:\/\/cookevillepediatrics.com\/wp-content\/uploads\/2022\/08\/V-Records-Release.pdf” link_option_url_new_window=”on” border_radii=”on|15px|15px|15px|15px” border_width_all=”3px” border_color_all=”#FFFFFF” box_shadow_style=”preset1″ box_shadow_vertical=”6px” box_shadow_color=”rgba(0,0,0,0.26)” global_colors_info=”{}” border_color_all__hover_enabled=”on|hover” border_color_all__hover=”#00a020″]<\/p>\n

Please use this form for authorization to release your childs medical records. Bring this on your first visit.<\/p>\n

[\/et_pb_blurb][\/et_pb_column][et_pb_column type=”1_2″ module_class=”image-full” _builder_version=”4.16″ _module_preset=”default” background_image=”https:\/\/cookevillepediatrics.com\/wp-content\/uploads\/2021\/12\/patient-form.jpg” background_position=”top_center” border_radii=”on|15px|15px|15px|15px” global_colors_info=”{}”][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=”1″ custom_padding_last_edited=”on|phone” _builder_version=”4.16″ _module_preset=”default” background_color=”#e2ebf6″ custom_padding=”50px||50px||false|false” custom_padding_tablet=”50px||50px||false|false” custom_padding_phone=”||50px||false|false” global_colors_info=”{}”][et_pb_row _builder_version=”4.16″ _module_preset=”default” custom_padding=”0px||||false|false” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][et_pb_text _builder_version=”4.16″ _module_preset=”default” header_2_font=”Poppins|700|||||||” header_2_text_align=”center” header_2_text_color=”#333333″ header_2_font_size=”30px” custom_margin=”||10px||false|false” global_colors_info=”{}”]<\/p>\n

Follow-Up Checkup Forms<\/h2>\n

[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row column_structure=”1_3,1_3,1_3″ use_custom_gutter=”on” gutter_width=”2″ make_equal=”on” module_class=”follow-ups” _builder_version=”4.16″ _module_preset=”default” width=”65%” custom_padding=”0px||0px||false|false” global_colors_info=”{}”][et_pb_column type=”1_3″ _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][et_pb_blurb title=”Patient Medical History” image=”https:\/\/cookevillepediatrics.com\/wp-content\/uploads\/2021\/12\/patient-history.png” image_icon_width=”80px” _builder_version=”4.17.4″ _module_preset=”default” header_font=”Poppins|600|||||||” header_text_color=”#333333″ header_font_size=”18px” body_font=”Poppins||||||||” body_text_color=”#666666″ body_font_size=”14px” body_line_height=”21px” background_color=”#FFFFFF” text_orientation=”center” custom_padding=”25px|15px|25px|15px|true|true” link_option_url=”https:\/\/cookevillepediatrics.com\/wp-content\/uploads\/2022\/09\/v-PAST-MEDICAL-HISTORY-FORM.pdf” link_option_url_new_window=”on” border_radii=”on|15px|15px|15px|15px” border_width_all=”3px” border_color_all=”#FFFFFF” box_shadow_style=”preset3″ box_shadow_horizontal=”10px” box_shadow_vertical=”15px” box_shadow_color=”rgba(0,0,0,0.15)” global_colors_info=”{}” border_color_all__hover_enabled=”on|hover” border_color_all__hover=”#00a020″]<\/p>\n

Please use this form to list pre-medical history. Bring this form with you on your first visit.<\/p>\n

[\/et_pb_blurb][\/et_pb_column][et_pb_column type=”1_3″ _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][et_pb_blurb title=”Prenatal Registration” image=”https:\/\/cookevillepediatrics.com\/wp-content\/uploads\/2021\/12\/patient-register.png” image_icon_width=”80px” _builder_version=”4.16″ _module_preset=”default” header_font=”Poppins|600|||||||” header_text_color=”#333333″ header_font_size=”18px” body_font=”Poppins||||||||” body_text_color=”#666666″ body_font_size=”14px” body_line_height=”21px” background_color=”#FFFFFF” text_orientation=”center” custom_padding=”25px|15px|25px|15px|true|true” link_option_url=”https:\/\/cookevillepediatrics.com\/wp-content\/uploads\/2021\/12\/Prenatal-Registration.pdf” link_option_url_new_window=”on” border_radii=”on|15px|15px|15px|15px” border_width_all=”3px” border_color_all=”#FFFFFF” box_shadow_style=”preset3″ box_shadow_horizontal=”10px” box_shadow_vertical=”15px” box_shadow_color=”rgba(0,0,0,0.15)” global_colors_info=”{}” border_color_all__hover=”#00a020″ border_color_all__hover_enabled=”on|hover”]<\/p>\n

Please use this form for prenatal registration. Bring this form with you on your first visit.<\/p>\n

[\/et_pb_blurb][\/et_pb_column][et_pb_column type=”1_3″ _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][et_pb_blurb title=”New Patient Package” image=”https:\/\/cookevillepediatrics.com\/wp-content\/uploads\/2021\/12\/new-patien-package.png” image_icon_width=”80px” _builder_version=”4.27.5″ _module_preset=”default” header_font=”Poppins|600|||||||” header_text_color=”#333333″ header_font_size=”18px” body_font=”Poppins||||||||” body_text_color=”#666666″ body_font_size=”14px” body_line_height=”21px” background_color=”#FFFFFF” text_orientation=”center” custom_padding=”25px|15px|25px|15px|true|true” link_option_url_new_window=”on” border_radii=”on|15px|15px|15px|15px” border_width_all=”3px” border_color_all=”#FFFFFF” box_shadow_style=”preset3″ box_shadow_horizontal=”10px” box_shadow_vertical=”15px” box_shadow_color=”rgba(0,0,0,0.15)” global_colors_info=”{}” border_color_all__hover=”#00a020″ border_color_all__hover_enabled=”on|hover” link_option_url=”@ET-DC@eyJkeW5hbWljIjp0cnVlLCJjb250ZW50IjoicG9zdF9saW5rX3VybF9hdHRhY2htZW50Iiwic2V0dGluZ3MiOnsicG9zdF9pZCI6IjEyNjkifX0=@” _dynamic_attributes=”link_option_url” hover_enabled=”0″ sticky_enabled=”0″]<\/p>\n

Please use this form for new patient registration. Bring this form with you on your first visit.<\/p>\n

[\/et_pb_blurb][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=”1″ custom_padding_last_edited=”on|phone” _builder_version=”4.16″ _module_preset=”default” background_color=”#FFFFFF” custom_padding_tablet=”” custom_padding_phone=”||20px||false|false” global_colors_info=”{}”][et_pb_row _builder_version=”4.16″ _module_preset=”default” custom_padding=”0px||||false|false” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][et_pb_text _builder_version=”4.16″ _module_preset=”default” header_2_font=”Poppins|700|||||||” header_2_text_align=”center” header_2_text_color=”#333333″ header_2_font_size=”30px” custom_margin=”||10px||false|false” global_colors_info=”{}”]<\/p>\n

First Visit Forms<\/h2>\n

[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row column_structure=”1_4,1_4,1_4,1_4″ use_custom_gutter=”on” gutter_width=”2″ _builder_version=”4.16″ _module_preset=”default” width=”81%” custom_padding=”0px||||false|false” global_colors_info=”{}”][et_pb_column type=”1_4″ _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][et_pb_blurb title=”3-5 Day Checkup” image=”https:\/\/cookevillepediatrics.com\/wp-content\/uploads\/2021\/12\/2-5day.png” image_icon_width=”80px” _builder_version=”4.17.4″ _module_preset=”default” header_font=”Poppins|600|||||||” header_text_color=”#333333″ header_font_size=”16px” body_font=”Poppins||||||||” body_text_color=”#666666″ body_font_size=”14px” body_line_height=”21px” background_color=”#FFFFFF” text_orientation=”center” custom_padding=”25px|15px|25px|15px|true|true” link_option_url=”https:\/\/cookevillepediatrics.com\/wp-content\/uploads\/2022\/08\/9-rsv-questionnaire-combined-combined.pdf” link_option_url_new_window=”on” border_radii=”on|15px|15px|15px|15px” border_width_all=”3px” border_color_all=”#FFFFFF” box_shadow_style=”preset1″ box_shadow_vertical=”6px” box_shadow_color=”rgba(0,0,0,0.26)” global_colors_info=”{}” border_color_all__hover_enabled=”on|hover” border_color_all__hover=”#00a020″]<\/p>\n

Regular checkups are a key for good health. Use this form for your child’s 3-5 day checkup.<\/p>\n

[\/et_pb_blurb][\/et_pb_column][et_pb_column type=”1_4″ _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][et_pb_blurb title=”1 Month Checkup” image=”https:\/\/cookevillepediatrics.com\/wp-content\/uploads\/2021\/12\/1month.png” image_icon_width=”80px” _builder_version=”4.17.4″ _module_preset=”default” header_font=”Poppins|600|||||||” header_text_color=”#333333″ header_font_size=”16px” body_font=”Poppins||||||||” body_text_color=”#666666″ body_font_size=”14px” body_line_height=”21px” background_color=”#FFFFFF” text_orientation=”center” custom_padding=”25px|15px|25px|15px|true|true” link_option_url=”https:\/\/cookevillepediatrics.com\/wp-content\/uploads\/2022\/08\/v-2-4-week-checkup-questionnaire-combined-combined.pdf” link_option_url_new_window=”on” border_radii=”on|15px|15px|15px|15px” border_width_all=”3px” border_color_all=”#FFFFFF” box_shadow_style=”preset1″ box_shadow_vertical=”6px” box_shadow_color=”rgba(0,0,0,0.26)” global_colors_info=”{}” border_color_all__hover=”#00a020″ border_color_all__hover_enabled=”on|hover”]<\/p>\n

Regular checkups are a key for good health. Use this form for your child’s 1 month checkup.<\/p>\n

[\/et_pb_blurb][\/et_pb_column][et_pb_column type=”1_4″ _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][et_pb_blurb title=”2 Month Checkup” image=”https:\/\/cookevillepediatrics.com\/wp-content\/uploads\/2021\/12\/2month.png” image_icon_width=”80px” _builder_version=”4.16″ _module_preset=”default” header_font=”Poppins|600|||||||” header_text_color=”#333333″ header_font_size=”16px” body_font=”Poppins||||||||” body_text_color=”#666666″ body_font_size=”14px” body_line_height=”21px” background_color=”#FFFFFF” text_orientation=”center” custom_padding=”25px|15px|25px|15px|true|true” link_option_url=”https:\/\/cookevillepediatrics.com\/wp-content\/uploads\/2021\/12\/2-Month-Old-Patient-Forms.pdf” link_option_url_new_window=”on” border_radii=”on|15px|15px|15px|15px” border_width_all=”3px” border_color_all=”#FFFFFF” box_shadow_style=”preset1″ box_shadow_vertical=”6px” box_shadow_color=”rgba(0,0,0,0.26)” global_colors_info=”{}” border_color_all__hover=”#00a020″ border_color_all__hover_enabled=”on|hover”]<\/p>\n

Regular checkups are a key for good health. Use this form for your child’s 2 month checkup.<\/p>\n

[\/et_pb_blurb][\/et_pb_column][et_pb_column type=”1_4″ _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][et_pb_blurb title=”4 Month Checkup” image=”https:\/\/cookevillepediatrics.com\/wp-content\/uploads\/2021\/12\/4month.png” image_icon_width=”80px” _builder_version=”4.17.4″ _module_preset=”default” header_font=”Poppins|600|||||||” header_text_color=”#333333″ header_font_size=”16px” body_font=”Poppins||||||||” body_text_color=”#666666″ body_font_size=”14px” body_line_height=”21px” background_color=”#FFFFFF” text_orientation=”center” custom_padding=”25px|15px|25px|15px|true|true” link_option_url=”https:\/\/cookevillepediatrics.com\/wp-content\/uploads\/2022\/08\/V-CPA-Bright-Futures-4-month-combined-combined.pdf” link_option_url_new_window=”on” border_radii=”on|15px|15px|15px|15px” border_width_all=”3px” border_color_all=”#FFFFFF” box_shadow_style=”preset1″ box_shadow_vertical=”6px” box_shadow_color=”rgba(0,0,0,0.26)” global_colors_info=”{}” border_color_all__hover=”#00a020″ border_color_all__hover_enabled=”on|hover”]<\/p>\n

Regular checkups are a key for good health. Use this form for your child’s 4 month checkup.<\/p>\n

[\/et_pb_blurb][\/et_pb_column][\/et_pb_row][et_pb_row column_structure=”1_4,1_4,1_4,1_4″ use_custom_gutter=”on” gutter_width=”2″ _builder_version=”4.16″ _module_preset=”default” width=”81%” custom_padding=”5px||||false|false” global_colors_info=”{}”][et_pb_column type=”1_4″ _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][et_pb_blurb title=”6 Month Checkup” image=”https:\/\/cookevillepediatrics.com\/wp-content\/uploads\/2021\/12\/6month.png” image_icon_width=”80px” _builder_version=”4.17.4″ _module_preset=”default” header_font=”Poppins|600|||||||” header_text_color=”#333333″ header_font_size=”16px” body_font=”Poppins||||||||” body_text_color=”#666666″ body_font_size=”14px” body_line_height=”21px” background_color=”#FFFFFF” text_orientation=”center” custom_padding=”25px|15px|25px|15px|true|true” link_option_url=”https:\/\/cookevillepediatrics.com\/wp-content\/uploads\/2022\/08\/v-6-mo-checkup-questionnaire-combined.pdf.pdf” link_option_url_new_window=”on” border_radii=”on|15px|15px|15px|15px” border_width_all=”3px” border_color_all=”#FFFFFF” box_shadow_style=”preset1″ box_shadow_vertical=”6px” box_shadow_color=”rgba(0,0,0,0.26)” global_colors_info=”{}” border_color_all__hover_enabled=”on|hover” border_color_all__hover=”#00a020″]<\/p>\n

Regular checkups are a key for good health. Use this form for your child’s 6 month checkup.<\/p>\n

[\/et_pb_blurb][\/et_pb_column][et_pb_column type=”1_4″ _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][et_pb_blurb title=”9 Month Checkup” image=”https:\/\/cookevillepediatrics.com\/wp-content\/uploads\/2021\/12\/9month.png” image_icon_width=”80px” _builder_version=”4.17.4″ _module_preset=”default” header_font=”Poppins|600|||||||” header_text_color=”#333333″ header_font_size=”16px” body_font=”Poppins||||||||” body_text_color=”#666666″ body_font_size=”14px” body_line_height=”21px” background_color=”#FFFFFF” text_orientation=”center” custom_padding=”25px|15px|25px|15px|true|true” link_option_url=”https:\/\/cookevillepediatrics.com\/wp-content\/uploads\/2022\/08\/V-9-month-Handouts.pdf” link_option_url_new_window=”on” border_radii=”on|15px|15px|15px|15px” border_width_all=”3px” border_color_all=”#FFFFFF” box_shadow_style=”preset1″ box_shadow_vertical=”6px” box_shadow_color=”rgba(0,0,0,0.26)” global_colors_info=”{}” border_color_all__hover=”#00a020″ border_color_all__hover_enabled=”on|hover”]<\/p>\n

Regular checkups are a key for good health. Use this form for your child’s 9 month checkup.<\/p>\n

[\/et_pb_blurb][\/et_pb_column][et_pb_column type=”1_4″ _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][et_pb_blurb title=”12 Month Checkup” image=”https:\/\/cookevillepediatrics.com\/wp-content\/uploads\/2021\/12\/2-5day.png” image_icon_width=”80px” _builder_version=”4.17.4″ _module_preset=”default” header_font=”Poppins|600|||||||” header_text_color=”#333333″ header_font_size=”16px” body_font=”Poppins||||||||” body_text_color=”#666666″ body_font_size=”14px” body_line_height=”21px” background_color=”#FFFFFF” text_orientation=”center” custom_padding=”25px|15px|25px|15px|true|true” link_option_url=”https:\/\/cookevillepediatrics.com\/wp-content\/uploads\/2022\/08\/v-12-month-questionnaire-combined-combined.pdf” link_option_url_new_window=”on” border_radii=”on|15px|15px|15px|15px” border_width_all=”3px” border_color_all=”#FFFFFF” box_shadow_style=”preset1″ box_shadow_vertical=”6px” box_shadow_color=”rgba(0,0,0,0.26)” global_colors_info=”{}” border_color_all__hover=”#00a020″ border_color_all__hover_enabled=”on|hover”]<\/p>\n

Regular checkups are a key for good health. Use this form for your child’s 12 month checkup.<\/p>\n

[\/et_pb_blurb][\/et_pb_column][et_pb_column type=”1_4″ _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][et_pb_blurb title=”18 Month Checkup” image=”https:\/\/cookevillepediatrics.com\/wp-content\/uploads\/2021\/12\/1month.png” image_icon_width=”80px” _builder_version=”4.17.4″ _module_preset=”default” header_font=”Poppins|600|||||||” header_text_color=”#333333″ header_font_size=”16px” body_font=”Poppins||||||||” body_text_color=”#666666″ body_font_size=”14px” body_line_height=”21px” background_color=”#FFFFFF” text_orientation=”center” custom_padding=”25px|15px|25px|15px|true|true” link_option_url=”https:\/\/cookevillepediatrics.com\/wp-content\/uploads\/2022\/08\/V-bright-futures-18-mo-combined-combined.pdf” link_option_url_new_window=”on” border_radii=”on|15px|15px|15px|15px” border_width_all=”3px” border_color_all=”#FFFFFF” box_shadow_style=”preset1″ box_shadow_vertical=”6px” box_shadow_color=”rgba(0,0,0,0.26)” global_colors_info=”{}” border_color_all__hover=”#00a020″ border_color_all__hover_enabled=”on|hover”]<\/p>\n

Regular checkups are a key for good health. Use this form for your child’s 18 month checkup.<\/p>\n

[\/et_pb_blurb][\/et_pb_column][\/et_pb_row][et_pb_row column_structure=”1_4,1_4,1_4,1_4″ use_custom_gutter=”on” gutter_width=”2″ _builder_version=”4.16″ _module_preset=”default” width=”81%” custom_padding=”5px||||false|false” global_colors_info=”{}”][et_pb_column type=”1_4″ _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][et_pb_blurb title=”2 Year Checkup” url_new_window=”on” image=”https:\/\/cookevillepediatrics.com\/wp-content\/uploads\/2021\/12\/2month.png” image_icon_width=”80px” _builder_version=”4.17.4″ _module_preset=”default” header_font=”Poppins|600|||||||” header_text_color=”#333333″ header_font_size=”16px” body_font=”Poppins||||||||” body_text_color=”#666666″ body_font_size=”14px” body_line_height=”21px” background_color=”#FFFFFF” text_orientation=”center” custom_padding=”25px|15px|25px|15px|true|true” link_option_url=”https:\/\/cookevillepediatrics.com\/wp-content\/uploads\/2022\/08\/v-2-yr-questionnaire-combined.pdf.pdf” link_option_url_new_window=”on” border_radii=”on|15px|15px|15px|15px” border_width_all=”3px” border_color_all=”#FFFFFF” box_shadow_style=”preset1″ box_shadow_vertical=”6px” box_shadow_color=”rgba(0,0,0,0.26)” global_colors_info=”{}” border_color_all__hover_enabled=”on|hover” border_color_all__hover=”#00a020″]<\/p>\n

Regular checkups are a key for good health. Use this form for your child’s 2 year checkup.<\/p>\n

[\/et_pb_blurb][\/et_pb_column][et_pb_column type=”1_4″ _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][et_pb_blurb title=”30 Month Checkup” image=”https:\/\/cookevillepediatrics.com\/wp-content\/uploads\/2021\/12\/4month.png” image_icon_width=”80px” _builder_version=”4.17.4″ _module_preset=”default” header_font=”Poppins|600|||||||” header_text_color=”#333333″ header_font_size=”16px” body_font=”Poppins||||||||” body_text_color=”#666666″ body_font_size=”14px” body_line_height=”21px” background_color=”#FFFFFF” text_orientation=”center” custom_padding=”25px|15px|25px|15px|true|true” link_option_url=”https:\/\/cookevillepediatrics.com\/wp-content\/uploads\/2022\/08\/V-CPA-30-month-ASQ-combined.pdf.pdf” link_option_url_new_window=”on” border_radii=”on|15px|15px|15px|15px” border_width_all=”3px” border_color_all=”#FFFFFF” box_shadow_style=”preset1″ box_shadow_vertical=”6px” box_shadow_color=”rgba(0,0,0,0.26)” global_colors_info=”{}” border_color_all__hover=”#00a020″ border_color_all__hover_enabled=”on|hover”]<\/p>\n

Regular checkups are a key for good health. Use this form for your child’s 30 month checkup.<\/p>\n

[\/et_pb_blurb][\/et_pb_column][et_pb_column type=”1_4″ _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][et_pb_blurb title=”3 Year Checkup” image=”https:\/\/cookevillepediatrics.com\/wp-content\/uploads\/2021\/12\/6month.png” image_icon_width=”80px” _builder_version=”4.17.4″ _module_preset=”default” header_font=”Poppins|600|||||||” header_text_color=”#333333″ header_font_size=”16px” body_font=”Poppins||||||||” body_text_color=”#666666″ body_font_size=”14px” body_line_height=”21px” background_color=”#FFFFFF” text_orientation=”center” custom_padding=”25px|15px|25px|15px|true|true” link_option_url=”https:\/\/cookevillepediatrics.com\/wp-content\/uploads\/2022\/08\/v-3-year-check-up-questionnaire-combined-combined.pdf.pdf” link_option_url_new_window=”on” border_radii=”on|15px|15px|15px|15px” border_width_all=”3px” border_color_all=”#FFFFFF” box_shadow_style=”preset1″ box_shadow_vertical=”6px” box_shadow_color=”rgba(0,0,0,0.26)” global_colors_info=”{}” border_color_all__hover=”#00a020″ border_color_all__hover_enabled=”on|hover”]<\/p>\n

Regular checkups are a key for good health. Use this form for your child’s 3 year checkup.<\/p>\n

[\/et_pb_blurb][\/et_pb_column][et_pb_column type=”1_4″ _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][et_pb_blurb title=”4 Year Checkup” image=”https:\/\/cookevillepediatrics.com\/wp-content\/uploads\/2021\/12\/9month.png” image_icon_width=”80px” _builder_version=”4.17.4″ _module_preset=”default” header_font=”Poppins|600|||||||” header_text_color=”#333333″ header_font_size=”16px” body_font=”Poppins||||||||” body_text_color=”#666666″ body_font_size=”14px” body_line_height=”21px” background_color=”#FFFFFF” text_orientation=”center” custom_padding=”25px|15px|25px|15px|true|true” link_option_url=”https:\/\/cookevillepediatrics.com\/wp-content\/uploads\/2022\/08\/V-4-Yr-Complete-Handouts.pdf” link_option_url_new_window=”on” border_radii=”on|15px|15px|15px|15px” border_width_all=”3px” border_color_all=”#FFFFFF” box_shadow_style=”preset1″ box_shadow_vertical=”6px” box_shadow_color=”rgba(0,0,0,0.26)” global_colors_info=”{}” border_color_all__hover=”#00a020″ border_color_all__hover_enabled=”on|hover”]<\/p>\n

Regular checkups are a key for good health. Use this form for your child’s 4 year checkup.<\/p>\n

[\/et_pb_blurb][\/et_pb_column][\/et_pb_row][et_pb_row column_structure=”1_4,1_4,1_4,1_4″ use_custom_gutter=”on” gutter_width=”2″ _builder_version=”4.16″ _module_preset=”default” width=”81%” custom_padding=”5px||||false|false” global_colors_info=”{}”][et_pb_column type=”1_4″ _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][et_pb_blurb title=”5 Year Checkup” url_new_window=”on” image=”https:\/\/cookevillepediatrics.com\/wp-content\/uploads\/2021\/12\/2-5day.png” image_icon_width=”80px” _builder_version=”4.17.4″ _module_preset=”default” header_font=”Poppins|600|||||||” header_text_color=”#333333″ header_font_size=”16px” body_font=”Poppins||||||||” body_text_color=”#666666″ body_font_size=”14px” body_line_height=”21px” background_color=”#FFFFFF” text_orientation=”center” custom_padding=”25px|15px|25px|15px|true|true” link_option_url=”https:\/\/cookevillepediatrics.com\/wp-content\/uploads\/2022\/08\/v-5-yr-Complete-Handouts.pdf” link_option_url_new_window=”on” border_radii=”on|15px|15px|15px|15px” border_width_all=”3px” border_color_all=”#FFFFFF” box_shadow_style=”preset1″ box_shadow_vertical=”6px” box_shadow_color=”rgba(0,0,0,0.26)” global_colors_info=”{}” border_color_all__hover_enabled=”on|hover” border_color_all__hover=”#00a020″]<\/p>\n

Regular checkups are a key for good health. Use this form for your child’s 5 year checkup.<\/p>\n

[\/et_pb_blurb][\/et_pb_column][et_pb_column type=”1_4″ _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][et_pb_blurb title=”6 Year Checkup” image=”https:\/\/cookevillepediatrics.com\/wp-content\/uploads\/2021\/12\/1month.png” image_icon_width=”80px” _builder_version=”4.17.4″ _module_preset=”default” header_font=”Poppins|600|||||||” header_text_color=”#333333″ header_font_size=”16px” body_font=”Poppins||||||||” body_text_color=”#666666″ body_font_size=”14px” body_line_height=”21px” background_color=”#FFFFFF” text_orientation=”center” custom_padding=”25px|15px|25px|15px|true|true” link_option_url=”https:\/\/cookevillepediatrics.com\/wp-content\/uploads\/2022\/08\/V-6-10-yr-Checkup-combined_2.pdf.pdf” link_option_url_new_window=”on” border_radii=”on|15px|15px|15px|15px” border_width_all=”3px” border_color_all=”#FFFFFF” box_shadow_style=”preset1″ box_shadow_vertical=”6px” box_shadow_color=”rgba(0,0,0,0.26)” global_colors_info=”{}” border_color_all__hover=”#00a020″ border_color_all__hover_enabled=”on|hover”]<\/p>\n

Regular checkups are a key for good health. Use this form for your child’s 6 year checkup.<\/p>\n

[\/et_pb_blurb][\/et_pb_column][et_pb_column type=”1_4″ _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][et_pb_blurb title=”7-8 Year Checkup” image=”https:\/\/cookevillepediatrics.com\/wp-content\/uploads\/2021\/12\/2month.png” image_icon_width=”80px” _builder_version=”4.17.4″ _module_preset=”default” header_font=”Poppins|600|||||||” header_text_color=”#333333″ header_font_size=”16px” body_font=”Poppins||||||||” body_text_color=”#666666″ body_font_size=”14px” body_line_height=”21px” background_color=”#FFFFFF” text_orientation=”center” custom_padding=”25px|15px|25px|15px|true|true” link_option_url=”https:\/\/cookevillepediatrics.com\/wp-content\/uploads\/2022\/08\/V-6-10-yr-Checkup-combined_1.pdf” link_option_url_new_window=”on” border_radii=”on|15px|15px|15px|15px” border_width_all=”3px” border_color_all=”#FFFFFF” box_shadow_style=”preset1″ box_shadow_vertical=”6px” box_shadow_color=”rgba(0,0,0,0.26)” global_colors_info=”{}” border_color_all__hover=”#00a020″ border_color_all__hover_enabled=”on|hover”]<\/p>\n

Regular checkups are a key for good health. Use this form for your child’s 7-8 year checkup.<\/p>\n

[\/et_pb_blurb][\/et_pb_column][et_pb_column type=”1_4″ _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][et_pb_blurb title=”9-10 Year Checkup” url_new_window=”on” image=”https:\/\/cookevillepediatrics.com\/wp-content\/uploads\/2021\/12\/4month.png” image_icon_width=”80px” _builder_version=”4.17.4″ _module_preset=”default” header_font=”Poppins|600|||||||” header_text_color=”#333333″ header_font_size=”16px” body_font=”Poppins||||||||” body_text_color=”#666666″ body_font_size=”14px” body_line_height=”21px” background_color=”#FFFFFF” text_orientation=”center” custom_padding=”25px|15px|25px|15px|true|true” link_option_url=”https:\/\/cookevillepediatrics.com\/wp-content\/uploads\/2022\/08\/V-6-10-yr-Checkup-combined.pdf” link_option_url_new_window=”on” border_radii=”on|15px|15px|15px|15px” border_width_all=”3px” border_color_all=”#FFFFFF” box_shadow_style=”preset1″ box_shadow_vertical=”6px” box_shadow_color=”rgba(0,0,0,0.26)” global_colors_info=”{}” border_color_all__hover=”#00a020″ border_color_all__hover_enabled=”on|hover”]<\/p>\n

Regular checkups are a key for good health. Use this form for your child’s 9-10 year checkup.<\/p>\n

[\/et_pb_blurb][\/et_pb_column][\/et_pb_row][et_pb_row column_structure=”1_4,1_4,1_4,1_4″ use_custom_gutter=”on” gutter_width=”2″ _builder_version=”4.16″ _module_preset=”default” width=”81%” custom_padding=”5px||0px||false|false” global_colors_info=”{}”][et_pb_column type=”1_4″ _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][et_pb_blurb title=”11-14 Year Checkup” url_new_window=”on” image=”https:\/\/cookevillepediatrics.com\/wp-content\/uploads\/2021\/12\/6month.png” image_icon_width=”80px” _builder_version=”4.17.4″ _module_preset=”default” header_font=”Poppins|600|||||||” header_text_color=”#333333″ header_font_size=”16px” body_font=”Poppins||||||||” body_text_color=”#666666″ body_font_size=”14px” body_line_height=”21px” background_color=”#FFFFFF” text_orientation=”center” custom_padding=”25px|15px|25px|15px|true|true” link_option_url=”https:\/\/cookevillepediatrics.com\/wp-content\/uploads\/2022\/08\/V-11-14-yr-paperwork.pdf” link_option_url_new_window=”on” border_radii=”on|15px|15px|15px|15px” border_width_all=”3px” border_color_all=”#FFFFFF” box_shadow_style=”preset1″ box_shadow_vertical=”6px” box_shadow_color=”rgba(0,0,0,0.26)” global_colors_info=”{}” border_color_all__hover_enabled=”on|hover” border_color_all__hover=”#00a020″ content__hover_enabled=”on|desktop” content__hover=”<\/p>\n

Regular checkups are a key for good health. Use this form for your child’s 11-14 year checkup.<\/p>\n

“]<\/p>\n

Regular checkups are a key for good health. Use this form for your child’s 11-14 year checkup.<\/p>\n

[\/et_pb_blurb][\/et_pb_column][et_pb_column type=”1_4″ _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][et_pb_blurb title=”15-17 Year Checkup” image=”https:\/\/cookevillepediatrics.com\/wp-content\/uploads\/2021\/12\/9month.png” image_icon_width=”80px” _builder_version=”4.17.4″ _module_preset=”default” header_font=”Poppins|600|||||||” header_text_color=”#333333″ header_font_size=”16px” body_font=”Poppins||||||||” body_text_color=”#666666″ body_font_size=”14px” body_line_height=”21px” background_color=”#FFFFFF” text_orientation=”center” custom_padding=”25px|15px|25px|15px|true|true” link_option_url=”https:\/\/cookevillepediatrics.com\/wp-content\/uploads\/2022\/08\/V-15-17-paperwork.pdf” link_option_url_new_window=”on” border_radii=”on|15px|15px|15px|15px” border_width_all=”3px” border_color_all=”#FFFFFF” box_shadow_style=”preset1″ box_shadow_vertical=”6px” box_shadow_color=”rgba(0,0,0,0.26)” global_colors_info=”{}” border_color_all__hover=”#00a020″ border_color_all__hover_enabled=”on|hover”]<\/p>\n

Regular checkups are a key for good health. Use this form for your child’s 15-17 year checkup.<\/p>\n

[\/et_pb_blurb][\/et_pb_column][et_pb_column type=”1_4″ _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][et_pb_blurb title=”18-21 Year Checkup” image=”https:\/\/cookevillepediatrics.com\/wp-content\/uploads\/2021\/12\/2-5day.png” image_icon_width=”80px” _builder_version=”4.17.4″ _module_preset=”default” header_font=”Poppins|600|||||||” header_text_color=”#333333″ header_font_size=”16px” body_font=”Poppins||||||||” body_text_color=”#666666″ body_font_size=”14px” body_line_height=”21px” background_color=”#FFFFFF” text_orientation=”center” custom_padding=”25px|15px|25px|15px|true|true” link_option_url=”https:\/\/cookevillepediatrics.com\/wp-content\/uploads\/2022\/08\/V-18-21-paperwork.pdf” link_option_url_new_window=”on” border_radii=”on|15px|15px|15px|15px” border_width_all=”3px” border_color_all=”#FFFFFF” box_shadow_style=”preset1″ box_shadow_vertical=”6px” box_shadow_color=”rgba(0,0,0,0.26)” global_colors_info=”{}” border_color_all__hover=”#00a020″ border_color_all__hover_enabled=”on|hover”]<\/p>\n

Regular checkups are a key for good health. Use this form for your child’s 18-21 year checkup.<\/p>\n

[\/et_pb_blurb][\/et_pb_column][et_pb_column type=”1_4″ _builder_version=”4.16″ _module_preset=”default” global_colors_info=”{}”][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"

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