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Pediatric Health History Form (Age 0-8yrs)

Pediatric History

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Prenatal History

Birth History

Early Childhood History

Childhood History

Authorization to Treat a Minor:

, a minor, do hereby authorize request and direct Drs. Croteau and/or O'Flaherty and whomever he/she may designate as assistant to perform in judgment any examination and chiropractic diagnosis or treatment which is deemed necessary.

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