Sample Comprehensive Review Of Academic Records Page 5

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Is the child noticeably different from siblings or peers in his/her rate of learning at home?
General Medical History:
Is there any child or family medical history that may be related to your child’s concerns?
 Allergies  Frequent colds  Ear infections  Ear tubes  Hearing problems  take any medication
 Accident  Head injury  High fevers  Seizures  Fainting  Experienced any traumatic events
 Vision problems  Glasses  Coordination problems  Wetting/Night  Wetting/Day  Soiled pants
Other:
___________________
Is there anything I haven’t asked you about that you think is important for me to know?
Organized by Beth Hoecker-Martinez (LBLESD), Leah Hinkle (GAPS), Claudia Nunez (LBLESD), 2014

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