FIM – Pediatric New Patient Part 5

Pediatric New Patient FMI Part 5

  • SYMPTOM REVIEW
    Please check all current symptoms occurring or present in the past 6 months.
  • READINESS ASSESSMENT
    Rate on a scale of: 5 (very willing) to 1 (not willing).

    In order to improve your child’s health, how willing is the patient in:
  • Rate on a sale of : 5 (very confident) to 1 (not confident at all)
  • Rate on a sale of : 5 (very supportive) to 1 (very unsupportive)
  • Rate on a scale of: 5 (very frequent contact) to 1 (very infrequent contact))
  • This is the last form of 5