Creative Development Developmental Screen
Thank you for your interest in completing an informal 30 minute developmental screen.  You will have the ability to accompany your child and meet with a speech and language therapist, occupational therapist, and/or physical therapist who will perform the screen and collect information from you through an interview. Please fill out the below information in order to assist the therapists with information about your child.  These developmental pre-screenings will take place the 3rd Monday of every month.

We are located at 30 Avon Meadow Lane, Avon CT 06001
Our office number is 860-284-9779

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Child's First/Last Name *
Birthday *
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Parent/Guardians First and Last Name *
Contact information of Child: phone number AND email address of parent/guardian *
Contact information of Child: Permanent address of child *
Age of Child  (birth to 6) *
Primary Concerns related to age appropriate developmental milestones.   *
Is your child being currently seen by any skilled service providers.  (i.e. birth to three, skilled occupational therapist, skilled speech and language therapist, skilled physical therapist, developmental pediatrician, ABA therapy) *
Preferred date *
Preferred time slot for screen (Screening time 9:00am-1:00 pm February 21  30 minute slots) ** We will do our best to accommodate ** *
How did you hear about our screen? *
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