Name: Address: Email Or Parent's Email* Phone # Age: Height: Birthday: Current Weight: Grade: Why did you come for this Health History? Who is your best friend? What is your favorite sport or activity? What are fun things you do with family? What are your favorite things to do when you are alone? When do you wake up? Do you ever wake up at night? Do you ever have nightmares? Do you get bellyaches? Do you get headaches or earaches? Does anything else hurt? What do you eat for breakfast, Lunch + Dinner? What do you eat/Drink for snacks?
