Toddlers Physical Therapy Questionnaire Child's Name * Child's Age * Parent's Name * Parent's Email * Does your child walk alone and run (ie. does not require assist or hand holding, does not lose balance often, does not walk on toes)? ---YesSometimesNoDoes your child walk up and down stairs (ie. does not crawl or scoot, does not move sideways with railing, does not trip or fall)? ---YesSometimesNoCan your child kick a ball without holding onto an object for support? ---YesSometimesNoCan your child stand on tiptoes? ---YesSometimesNoCan your child throw a ball overhand? ---YesSometimesNoCan your child jump in place (ie. feet clear the floor)? ---YesSometimesNoDoes your child run at comfortable speech in one direction and around obstacles? ---YesSometimesNo* Human Verification: