tampa children’s ent test intake form

Tampa Children's ENT - TEST INTAKE FORM

Weight Loss Questionnaire

Name
Name
First
Last
Not interested --> Very interested
Not ready --> Very Ready
No support --> Much support
No support --> Much support
200
lbs.
200
lbs.
Medical History:
Activities of Daily Living: (what activities cause difficulty or pain?)
ADA Compliance Icon
Close Icon

Accessibility Adjustments

Close Icon Reset Options
Statement
Hide Interface
Content Adjustments

Emphasize Titles

Text Magnifier

Align Left

Align Center

Align Right

Adjust Letter Spacing
0%
Adjust Word Spacing
0%
Adjust Font Size
0%
Adjust Line Height
0%
Color Adjustments

Dark Mode

Light Mode

Monochrome

High Contrast

High Saturation

Low Saturation

Adjust Text Colors

Cancel

Adjust Title Colors

Cancel

Adjust Background Colors

Cancel
Orientation Adjustments

Stop Animation

Large Black Cursor

Large White Cursor