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

Race:

Ethnicity:

In the past year, did you ever eat less than you felt you should because there wasn’t enough money for food?

Does transportation keep you from medical appointments, work, or from getting things you need?

Are you worried that in the next 2 months, you may not have stable housing?

Do problems getting child care make it difficult for you to work or study?

Do you feel physically or emotionally unsafe where you currently live?

In the past year, have you been afraid of your partner or ex-partner?

Do you feel unsupported by those around you? (friends, family, church, etc.)

Do you feel overly stressed? (tense, nervous, anxious, or can’t sleep)

In the past 6 months, have you or anyone you live with been unable to get any of the following?

Clothing

Health Care

Utilities

Medication

Phone

Employment

Child Care

If you answered ”Yes” to any boxes above, would you like to receive assistance with any of these needs?

Are any of your needs urgent? (For example: I don’t have food tonight, I don’t have a place to sleep tonight)

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

Copyright © 2021-2023 Pediatrics of Queen Creek | All Rights Reserved

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