Ages & Stages Questionnaires (ASQ) are designed to assist our medical staff with identifying and/or monitoring children with possible developmental delays. These assessment forms can be completed prior to your coinciding appointment and brought with you, or a copy will be supplied at your appointment to complete.
2 MO ASQ (pdf)
Download4 MO ASQ (pdf)
Download6 MO ASQ (pdf)
Download9 MO ASQ (pdf)
Download12 MO ASQ (pdf)
Download14 MO ASQ - COMPLETED AT 15 MO (pdf)
Download18 MO ASQ (pdf)
Download24 MO ASQ (pdf)
Download30 MO ASQ (pdf)
Download36 MO ASQ (pdf)
Download48 MO ASQ (pdf)
Download60 MO ASQ (pdf)
DownloadMCHAT - COMPLETED AT 18 MO AND AGAIN AT 24 MO (pdf)
DownloadPlease complete these screens once a year, during the physical, for children between the ages of 11-17. There is a PARENT version, to be completed by a parent or caregiver and a CHILD version, to be completed by the child. Please complete them independently, as they will be reviewed and compared during the appointment. These screenings help our staff to ensure any cognitive, emotional, and behavioral problems are recognized, so appropriate interventions can be initiated.
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