Intake Assessment Form Page 5
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6INTAKE ASSESSMENT FORM
Children’s information
Does the child/ren have any special needs?
Does the child have any allergies?
Is the child diagnosed with any medical conditions?
Is the child diagnosed with any behaviour mental health concerns?
Does the child take any regular medication?
School/Daycare centre child attends
Medicare Card ……………………………………………………………………………………………..
Health Care Card number……………………………………………………………………………..
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