6 month old Questionnaires Patient Name * First Name Last Name Birthday * MM DD YYYY Do you have any concerns about how your child talks and makes speech sounds? * NO YES A little Do you have any concerns about how your child understands what you say? * NO YES A little Do you have any concerns about how your child uses his or her hands and fingers to do things? * NO YES A little Do you have any concerns about how your child uses his or her arms or legs? * NO YES A little Do you have any concerns about how your child behaves? * NO YES A little Do you have any concerns about how your child gets a long with others? * NO YES A little Do you have any concerns about how your child is learning to do things for him/herself? * NO YES A little Do you have any concerns about how your child is learning preschool skills? * NO YES A little Please explain further any "YES" or "A little" responses from above. * Please list any other concerns. * Thank you!
