Peirson Center for Children
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Please fill out the following forms on your computer.
  • Save your form by selecting the print icon.
  • Within the print screen select "save as PDF" in the destination drop down menu.
  • Label your documents with the patient's last name. 
  • Submit your forms here.
Pediatric History Form
Thiamine Deficiency Questionnaire

Adult History Form
This web site offers health, wellness, and nutritional information and is provided for informational purposes only. This information is not intended as a substitute for the advice provided by your physician or other healthcare professional. The use of any information provided on this web site is solely at your own risk. Nothing stated or posted on this website by The Peirson Center for Children are intended to be, and must not be taken to be, the practice of medicine. Information provided on this website does not create a doctor-patient relationship between you and any doctor affiliated with our web site. Information and statements regarding dietary supplements have not been evaluated by the Food and Drug Administration and are not intended to diagnose, treat, cure, or prevent any disease

©  2023. Peirson Center for Children. All rights reserved
8100 W. Marigold St. #140611
Garden City, ID 83714