Infants (0-18 months) Physical Therapy Questionnaire Child's Name * Child's Age * Parent's Name * Parent's Email * While lying on her back, does your child track toys/faces to the sides and reach for toys with both hands? Does your child bring toys to the front of her chest? ---YesSometimesNoDoes your child have problem behaviors that impact the family's daily life? ---YesSometimesNoDoes your child roll from back to tummy (ie. over both sides, is successful on first attempt to roll)? ---YesSometimesNoDoes your child sit and reach for toys without falling (ie. has straight back, can use both arms at the same time, uses both hands equally, does not need to use one hand to maintain sitting)? ---YesSometimesNoDoes your child creep on hands and knees with alternate arm and leg movements (ie. moves steadily, uses both sides of body to move, uses arms and legs equally)? ---YesSometimesNoDoes your child pull to stand and cruise along furniture (ie. does not have stiff legs and pointed toes, does not only use arms to pull up)? ---YesSometimesNoDoes your child stand alone and take several independent steps (ie. does not require help or furniture to stand, does not only use arms to stand)? ---YesSometimesNo* Human Verification:
301-577-4333 (Lanham, MD) 301-577-4333 (Lanham, MD)