11 Year Physical
A
TB RISK ASSESSMENT form needs to be completed.
A
NUTRITION QUESTIONNAIRE needs to be completed.
A
PSC QUESTIONNAIRE needs to be completed only for patients
with MassHealth, BMC, or Children’s Medical Security Plan insurance. If your child
has any other type of health insurance, this form will not be needed.
Please click on the above links, print and complete the
forms, and bring them with you to the appointment.
The following immunizations are usually given at this visit:
Please click on each of the above vaccine names to learn
more about each vaccine.
Your provider will decide if any or all of the above
immunizations are needed at this visit.
Additional immunizations might also be recommended.
Your provider will decide if any labwork is needed.
Your provider will decide if a vision screen or hearing test
is needed.
We will be discussing nutrition, school, and safety issues plus any other
concerns that you have.
