Questionnaire

Your answers will be kept confidential; this information will only be used for reporting purposes and will not be combined with other information we gain through your visits
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    Behavior Questionnaire

    Please answer the following questions as best you can. Answer 2 (Usually) if your child usually performs the behavior without help or reminders; or if he/she performed the behavior at a younger age but now has outgrown it. Answer 1 (Sometimes or Partially) if your child sometimes performs the behavior without help or reminders; or performs part of the behavior without help or reminders. Answer 0 (Never) if you child never performs the behavior without help or reminders; or because he/she is: too unable, too young, not allowed. Answer DK (Don't Know) if you have never seen your child perform the behavior and don't know whether he/she performs it.

    Listening and Understanding

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    Talking

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    Relating to Others

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    Using Large Muscles

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    Using Small Muscles

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