Surveys and Questionnaires
| English |
| Ages and Stages Questionnaire (ASQ) and age appropriate activity sheets |
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. |
| Modified Checklist for Autism in Toddlers (M-CHAT) |
|
A checklist to evaluate toddlers at the 18 or 24 month Well Child Check. |
| GAPS Questionnaire: |
|
The Guidelines for Adolescent Preventive Services (GAPS) Questionnaire is a comprehensive screening tool designed to address the special needs of adolescents.
|
| CGI-P: Conners' Global Index |
A test used to help assess attention deficit/hyperactivity disorder (ADHD) and evaluate problem behavior in children and adolescents. |
| Vanderbilt Index |
A test used in the diagnosis and evaluation of children with ADHD. |
| Adolescent Health Evaluation – American Fork Office |
|
A health questionnaire to evaluate adolescents. Please bring your completed survey with you to your visit with your pediatrician. |
| Weight Management |
|
| Social - Emotional Ages and Stages Questionnaire (ASQ:SE) & age appropriate activity sheets |
|
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. |
| Spanish |
| Edades y Etapas Cuestionario (ASQ) y hojas edad-apropiadas de actividades |
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. |
| Sistema Vanderbilt de Evaluación: |
|
Una prueba utilizados en el diagnóstico y la evaluación de los niños con TDAH. |
| Guía De Servicios Preventivos Adolescentes Cuestionario (GAPS): |
|
The Guidelines for Adolescent Preventive Services (GAPS) Questionnaire is a comprehensive screening tool designed to address the special needs of adolescents.
|
| Edades y Etapas Cuestionario: Social-Emocional (ASQ:SE) y hojas edad-apropiadas de actividades |
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. |
Download Form
Get To Know Us
After Hours Information Find Our Clinics Pay Your Bill Online What’s New Leave Us a Review
Is Your Child Sick?
Health Information
Importance of Well-Child or Preventative Visits Ages and Stages Questionnaires Topics A to Z Medicine/Dosages Surveys and Questionnaires Seasonal Tips for Parents
