Were there any complications or concerns during pregnancy with the child?
Were there any complications or concerns during, or immediately following the child's birth?
Were there any concerns regarding the child's early development? If so, please explain:
At what age did your child sit alone?
At what age did you child crawl?
At what age did your child walk alone?
At what age did your child babble?
At what age did your child speak first words?
At what age did your child speak in sentences?
At what age was your child toilet trained (day)?
At what age was your child toilet trained (night)?
Have any other services assisted with your child's development?
What year or age were the services involved?
Has your child ever completed a speech or language assessment?
If so, do you know the assessment date or results?
Has your child ever had a cognitive assessment (WPPSI, WISC)?
If so, do you know the assessment date and results?
Has the child been previously diagnosed with any developmental disorders, or medical conditions?
If relevant, what medication does your child take?
Has your child had a hearing test?
If so, what was the date and results?
Has your child had a vision test?
If so, what was the date and results?
