Personal care for a personal town.

Three Locations Servicings Our Pediatrics Family in the East Valley

Monday – Friday: 8:00 AM - 4:30 PM
Saturday and Sunday: Closed
Closed on Major Holidays

SDOH Form

Check the phrase that best applies to your situation

1.Do you have access to a park or places for recreation?

2.Do you need help with transportation to get to your doctor’s appointments?

3. Do you ever need help filling out medical forms, reading prescription labels, understanding how to take your pills, or following doctors’ instructions?

4. Are there others in your family or support system who should be informed and consulted regarding your medical care? Who are they and what is their relationship to you?

5.How often do you skip doses or forget to take medicines prescribed for you?

6.Does your family have access to a quality education and job opportunities?

7.Do you have access to fresh fruits and vegetables?

8.Do you feel that your physical health is affecting your spiritual life?

9. Do you go back to your native country or visit other foreign countries to have medical treatments, buy medicine or obtain specific herbal remedies?

10.Do you have enough money to buy the things you need to live everyday such as food, clothing, housing, and/or utilities?

11.Do you see a native healer or non-traditional practitioner (curandero, espiritista, santero) when you feel illl?

12.Are you able to get medical care when you need it?

13.Does anyone in your family have problems with substance or alcohol abuse?

14.Do you feel discriminated, bullied against, or isolated at work/school/community?

15.Do you take non-prescribed herbal or folk medicine for your medical conditions or general health?

Personal care for a personal town.

Three Locations Servicings Our Pediatrics Family in the East Valley

Taking care of your children is our highest priority. We know that raising a child is a rewarding – and very challenging – experience for all parents.

Our Info

22707 S Ellsworth Rd,
Suite H101
Queen Creek, AZ. 85142
(near Ellsworth and Ocotillo Rds)

(480) 792-9200

Fax: (480) 792-9206

info@pediatricsqc.com

Monday – Friday: 8:00 AM - 4:30 PM
Saturday and Sunday: Closed

Closed on Major Holidays

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