Table of Contents


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.

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Modified Checklist for Autism in Toddlers (M-CHAT)

A checklist to evaluate toddlers at the 18 or 24 month Well Child Check.

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Surveys for the 18 and 24 Month Well Child Check

For the 18 and 24 month well child check visits, you will need to fill out both the ASQ and the M-CHAT. These are surveys that will help screen for any developmental delays. Please bring both completed survey with you to your visit with your child's pediatrician.

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GAPS Questionnaire:

The Guidelines for Adolescent Preventive Services (GAPS) Questionnaire is a comprehensive screening tool designed to address the special needs of adolescents.

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CGI-P: Conners' Global Index

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

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Vanderbilt Index

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

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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.

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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. Do not use these surveys unless specifically asked to use the Social and Emotional ASQ. The ASQ questionnaires needed for well child visits are here.

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Emergency Contact Sheet

In an emergency, you rarely have the time to stop and look up a number. An emergency contact sheet is a great way of making sure you have all the information you need right in front of you. Just download the PDF, print it, fill it out, and stick a copy by the phone and in your car. And be sure your children and anybody watching your children know where it is.

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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.

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Sistema Vanderbilt de Evaluación:

Una prueba utilizados en el diagnóstico y la evaluación de los niños con TDAH.

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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.

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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.

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Cuestionario M-CHAT Revisado de Detección del Autismo en Niños Pequeños

A checklist to evaluate toddlers at the 18 or 24 month Well Child Check.

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Severity Measure for Depression - Child Age 11-17

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The Patient Health Questionnaire – 2

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Screen for Child Anxiety Related Disorders (SCARED) - Child Version

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Screen for Child Anxiety Related Disorders (SCARED) - Parent Version

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