HELPFUL INFORMATION ABOUT YOUR CHILD - INFANT

Child's Name *

Date of Birth * +

DEVELOPMENTAL HISTORY

Does your child have any nicknames he/she likes? *

Age child began:

Sitting *

Crawling *

Walking *

Talking *

Does your child do any of the following? *

Pull Up

Crawl

Walk With Support

Walk Independently

Times child is fussy: *

How do you handle fussy times? *