Developmental Overview

This information serves as a baseline assessment to determine how we can best assist your child in his/her development. The information is strictly confidential and will not be shared without written permission from the parents/guardians

Child's Name:

First Last

Date Completed:

Birth

Type of Birth:

Caesarean Section

Natural Birth

At how many weeks was your child born?

Were there any complications during the birth? Please explain

Milestones:

Head control:

Gripping:

Sitting:

Crawling:

First Words:

Walking:

Solids:

Does your child have any habits (like nail biting for example) that you would like us to be aware of?

Does your child have any special medical, physical or emotional needs that you would like us to be aware of?

Are there any foods or drinks that your child cannot have that we need to be aware of?

Has your child had any accidents or operations that you would like us to be aware of?

Do you have any specific concerns about an aspect of your child's development?

Is there anything else that you feel is important for us to be aware of with regards to your child's development?

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Developmental Overview

Birth

Milestones: