Downloadable Forms
When you contact the Epidermolysis Bullosa Center at Cincinnati Children's Hospital Medical Center, one of our staff will mail you a packet of information. Included will be forms to fill out so that we can be familiar with your child and his / her other medical history before the clinic visit.
To get started on the information packet, you may download the patient forms in portable document format (.pdf) or Microsoft Word:
Child Patient Questionnaire .pdf (254k)
Word (556k)
Adult Patient Questionnaire .pdf (245k)
Word (537k)
List of Providers / Services Form .pdf (53k)
Word (101k)
Food Intake Form .pdf (32k)
Word (1064k)
Please record three days of intake Instructions for Food Intake Form .pdf (94k)
Please fill out all of the forms completely and return them as soon as possible. The completed forms can be sent to the Epidermolysis Bullosa Center at Cincinnati Children's by mail or email. Visit our Contact Us page for complete mailing information.
An official appointment cannot be scheduled until all completed forms are returned to us. Once we have received the forms we will contact you to confirm your appointment date and time.
You must have Adobe Acrobat" Reader installed on your computer to read this file. You can download Adobe Acrobat" Reader at Adobe's Web site by selecting the version appropriate for your type of computer.
