For all new patients

Please bring a copy of your insurance card. Please plan an extra 30 minutes for your visit. For well visits we like to be able to review past medical records at least 1 week prior to the visit.

  • HIPAA release of medical record
  • SW pediatrics registration form
  • Family history questionnaire

Newborn

(typically 24-48 hours after discharge home from hospital)
Please bring warm blanket, extra diapers and wipes, bottle or pacifier. Your current insurance card.

  • SW pediatrics Registration form
  • Family history questionnaire

1 Week

Please bring a warm blanket, extra diapers and wipes and a bottle or pacifier for soothing

1 Month

Please bring updated baby’s insurance card, a warm blanket to keep covered during exam. Bottle or pacifier for soothing after and during exam.

  • Edenborough postpartum depression screen

Vaccine: Hepatitis B #2

2 months

Please bring a warm blanket, extra diapers and wipes and a bottle or pacifier.

Vaccine: Dtap, IPV, Hib, Prevnar 13 and Rotateq

4 months

Please bring a warm blanket, extra diapers and wipes and a bottle or pacifier.

Vaccine: Dtap, IPV, Hib, Prevnar 13 and Rotateq

6 months

Please bring a warm blanket, extra diapers and wipes, bottle, pacifier or teething toy (rattle).

Vaccine: Dtap, IPV, Hib, Prevnar 13 and Rotateq (flu vaccine if in season)

9 months

Please bring a warm blanket, extra diapers and wipes and a bottle or pacifier. Having some snacks may be helpful if near meal time.

  • Developmental Screening questionnaire: 9 month Ages and Stages Questionnaire
  • Lead Screen questionnaire

Vaccines: Hepatitis B # 3 (flu vaccine if in season)
Lab Testing: Hemoglobin (iron screen), Lead testing

12 months

Your child will be undressed for weighing and measuring. Ok to replace onesie for warmth. Please bring toy or book for entertainment. Sippy cup for water if needed.

Vaccines: MMR and Varicella (Chicken Pox) (flu vaccine if in season)

15 months

Your child will be undressed for weighing and measuring. Ok to replace onesie for warmth. Please bring toy or book for entertainment. Sippy cup for water if needed.

Vaccines: MMR and Varicella (Chicken Pox) (flu vaccine if in season)

18 months

Your child will be undressed for weighing and measuring. Ok to replace onesie/ shirt for warmth. Please bring toy or book for entertainment, crayons for coloring, sippy cup for water if needed.

  • Developmental Screening questionnaire: 18 month Ages and Stages
  • Lead screening

Vaccines: Hepatitis A #1 (catch-up) (flu vaccine if in season)
Lab Tests: Second lead test if needed

24 month

(2 year)
Have your child wear pants/ shorts and shirt for ease of examining. Please bring entertainment toy, book, crayons, snack and sippy cup.

  • Developmental Screening questionnaire: 24 month Ages and Stages
  • Lead screening if not completed
  • TB screen

Vaccine: Hepatitis A #2 and catch-up (flu vaccine if in season)

3 year

Have your child wear pants/ shorts and shirt for ease of examining. Please bring entertainment toy, book, crayons, snack and sippy cup.

Vaccine: none if up-to-date! Flu shot if season.

4 year

Have your child wear pants/ shorts and shirt for ease of examining. Please bring entertainment toy, book, crayons, snack and sippy cup.

Labs: none
Vaccines: MMR #2 and Varicella (chicken pox #2), (flu vaccine if season)

5 year

(Kindergarten if completed after March 31st)
Please note that prior to kindergarten your child will need an eye exam by optometrist and pediatric dental screen.

Have your child wear pants/ shorts and shirt for ease of examining. Please bring entertainment toy, book, crayons, snack and sippy cup.

  • Lead screen
  • TB screen

Vaccines: Dtap and IPV, catch-up and seasonal flu vaccine

6-10 year

We recommend yearly visits to monitor your child’s growth and emotional development. These visits allow us to complete necessary school and camp physicals. Please book extra time to discuss academic issues or emotional issues. Children should wear loose fitting clothes able to be lifted up from the waist and pulled down.

  • Permission for medication administration at school
  • School inhaler forms
  • Allergy action plan

Vaccines: catch-up immunization, seasonal flu vaccine

11-12 year

(6th grade)
A physical prior to entering sixth grade is required. Some schools will also require a PR participation sports physical (this is good for 13 months) Please bring a first morning urine sample for the sixth grade physical Your pre-teen should wear loose fitting clothes able to be lifted up from the waist and pulled down. At this visit puberty will be discussed.

  • Illinois Sports clearance form (IHA)
  • permission for medication administration at school
  • school inhaler forms
  • allergy action plan

Vaccines: Tdap, Menectra (Meningitis) and HPV 3 shot series

13-14

(freshman year)
A physical prior to entering freshman year is required and many schools require a yearly sports physical for clearance for interschool competition. Remember all sports clearance physical are good for 13 months! For the freshman physical we need a first morning urine sample. Due to the risk of teenage suicide and mental illness, your teenager will complete a depression screen in the office that we will update this every 13 months. Results will be shared with you. Please have your teen dress in loose fitting clothes that can be pulled up and down from the waist.

  • Illinois Sports clearance form (IHA)
  • permission for medication administration at school
  • school inhaler forms
  • allergy action plan

Vaccines: catch-up HPV series, flu shot if needed

15-17

Yearly physicals are required for clearance for participation in school sports every 13 months. We recommend yearly physicals. At this visit we may ask that parents step out of the room to allow your teenager an opportunity to be candid. Due to the risk of teenage suicide and mental illness, your teenager will complete a depression screen in the office. Results will be shared with you. Please have your teen dress in loose fitting clothes that can be pulled up and down from the waist.

  • Illinois Sports clearance form (IHA)
  • permission for medication administration at school
  • school inhaler forms
  • allergy action plan

Vaccines: Menectra (meningitis booster) prior to senior year, catch-up HPV series and seasonal flu shot

15-17

Yearly physicals are required for clearance for participation in school sports every 13 months. We recommend yearly physicals. At this visit we may ask that parents step out of the room to allow your teenager an opportunity to be candid. Due to the risk of teenage suicide and mental illness, your teenager will complete a depression screen in the office. Results will be shared with you. Please have your teen dress in loose fitting clothes that can be pulled up and down from the waist.

  • Illinois Sports clearance form (IHA)
  • permission for medication administration at school
  • school inhaler forms
  • allergy action plan

Vaccines: Menectra (meningitis booster) prior to senior year, catch-up HPV series and seasonal flu shot

18+

Many colleges will require an entrance physical. Each school varies on their requirements for vaccines and also tuberculosis testing. If your child will be participating in intercollegiate activities, a physical will be required and the NCAA requires proof of sickle cell screening. In addition, because your teen is now 18, to speak with you about your teen without them present we will need a release of information. We will continue to see your teen throughout college.

  • 18+ consent to release information
  • health care transition forms

Vaccines: menactra #2 if not previously given.