Child Development Check-In Form
At anytime, a family can request an Ages and Stages Questionnaire (ASQ3) to determine where your child is on their developmental journey. Once a year, we will formally send out a questionnaire to families with children between 3 and 4 years of age. We will be mailing these out in September. If you have not received a questionnaire or have concerns prior, please complete this online form.
Child's Full Name
Child's Date of Birth
Parent/Guardian's Full Name
Language used in the home
Please check if there are any specific areas of concern:
Voice (e.g. significantly hoarse)
Speech Sounds (e.g. child’s speech is difficult to understand)
Language (e.g. child has difficulty understanding language and/or using words to communicate)
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