36 Month Questionnaire
34  Months 16 Days  through  38 Months 15 days  


First, your concern for your child's development shows that you are a great advocate for your child's future.

Early and correct mastery of skills insures that your child will be able to succeed in school and in life.


The questions below are age specific. Be sure your child falls within the age range listed at the top of this form.

Scroll to the bottom of each page and click the NEXT button to go to the next section.

You must answer each question. If you are not sure of the answer do your best. It is better to NOT give your child credit if you are not sure if they can perform the task. Try each activity with your child before marking a response. Make the activities fun.  Make sure your child is in a good mood, rested and fed.

After you submit the form we will email you the results within 72 hours.

If you have questions please email us at  info@Therapy4kids.net or call 501.514.3722

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Email *
Child's name *
Child's Date of Birth *
MM
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DD
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YYYY
Parent-Guardian Name *
Where do you live?  City and State *
How did you hear about this screening? If preschool, which one? *
Who We Are:
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