Pregnancy History. Did mother have access to prenatal care? □ Yes □ No □ Info N/A Was youth exposed to toxins before birth? □ Yes □ No □ Info N/A If yes, specify type (i.e., prescription medications, illegal substances, etc.): Length of pregnancy: □ Pre-term □ Term □ Post-term Complications at birth: Temperment as an infant:
Appears in 7 contracts
Samples: Therapist Agreement, Therapist Agreement, www.summitmedicalgroup.com
