Thank you so much for taking the time to fill out this form. This is a generic form, so some of the information will not apply to your child. However, please fill it out as completely as possible. You play a critical role in your child’s life and getting a complete medical and social history is a crucial part in the evaluation process. The pertinent information on this form will be included in the evaluation report, however, this form and the report will be kept confidential and remain in your child’s secured clinical file. This information can only be released to others with your written permission.