Developmental Screening Forms

Reading Pediatrics uses the following developmental screenings as tools for the early recognition and treatment of children with any developmental or behavioral disabilities such as autism, intellectual disabilities, or Attention-Deficit/Hyperactivity Disorder.

These screenings can be used to tell if your child is learning basic skills when they should, or if there might be any concerns in their development. Your child’s doctor may ask you questions or talk and play with your child during an exam to see how he or she learns, speaks, behaves, and moves. Since there is no lab or blood test to tell if your child may have a delay, the developmental screening will help tell if your child needs to see a specialist.

In an effort to reduce your waiting time during your visit, we ask that you take a few minutes to fill out the screenings that pertain to your child’s age prior to your visit. You can bring this form with you to hand to the front desk at the time of your visit.
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  • 4-6 Months Ages & Stages/ Social-Emotional Screening

  • 9-12 Months Ages & Stages/ Social-Emotional Screening

  • 15 Months Ages & Stages/ Social-Emotional Screening

  • 18 & 24 Months Modified Checklist for Autism in Toddlers

  • 3 Years Old Peds Response Form

  • 4-11 Years Old Pediatric Symptom Checklist

  • 12-17 Years Old Pediatric Symptom Checklist – Youth Report