We would like to make your child’s visit as comfortable as possible and we would appreciate if you could give us some information about them.

This information will only be shared with staff directly involved in your child’s care.

If you would rather not share these details, please do not complete this form.

Our Doctors and Nurses will use this to get to know your child and engage with them about things they like and are interested in.

Child's Name

Child's Preferred Name (if different to the above)

I have (?) brothers and (?) sisters

My favourite colour is

I really love (this might be a TV show, activity or something else)

I don't like

When I'm worried, upset or scared, I feel better when

My happiest memory is when

Any further information about your child you would like the doctors or nurses to know?

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