The ASQ is a screening tool to identify developmental delays in infants and young children during the crucial first 5 years of life. Parents complete a 30 item questionnaire which asks about a child's progress in five key developmental areas – communication, gross motor, fine motor, problem solving, and personal-social skills. The questionnaire takes about 10 to 20 minutes to complete. Please bring your completed survey with you to your visit with your child's pediatrician.

Index of Questionnaires >>

The ASQ:SE is a screening tool, meant to be used in conjunction with the ASQ, to identify the need for further social and emotional behavior assessment in children from ages 6 to 60 months.

Index of Questionnaires >>

A test used to help assess attention deficit/hyperactivity disorder (ADHD) and evaluate problem behavior in children and adolescents.

Download Parent Version

A test used in the diagnosis and evaluation of children with ADHD.

Parent Version / Teacher Version

Parent Follow Up / Teacher Follow Up

Weight Management Questionnaire Twelve years old and younger.
Weight Management Questionnaire Thirteen years and older.
Track it
Healthy Habits Book
Habit Builder
Prescription for Kids, Teens and Families
Prescription for Kids, Teens and Families (Spanish)

Use this form to:
- Request medical records to be sent to Utah Valley Pediatrics from another physician.
- Send medical records from Utah Valley Pediatrics to another physician (transferring care).
- Authorize the release of protected health information to another individual.

Download Form

Print the form, complete the appropriate sections and either fax it, mail it or bring it in to your physician's office. Fax numbers and addresses are listed on the Offices, Locations page.

El ASQ es una herramienta de la investigación para identificar retrasos en el desarrollo en infantes y niños jóvenes durante los primeros 5 años cruciales de la vida. Los padres llenan un cuestionario de 30 artículos que pregunte por el progreso de un niño en cinco áreas de desarrollo dominantes - comunicación, motor grueso, motor fino, el resolver de problema, y habilidades personal-sociales. El cuestionario tarda de 10 a 20 minutos para terminar. Traiga por favor este cuestionario terminado con usted a su visita con el pediatra de su niño.

Los Cuestionarios >>

El ASQ:SE es una herramienta de la investigación, significada para ser utilizado conjuntamente con el ASQ, para identificar la necesidad del gravamen social y emocional adicional del comportamiento en niños de edades 6 a 60 meses.

Los Cuestionarios >>