Name
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First Name
Last Name
Email
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Phone
*
(###)
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Speech
Speech is 70-80% intelligible
Produces consonant sounds: K, G, F, Y
Produces syllable shape CV - consonant + vowel (e.g., no, go)
Produces syllable shape VC - vowel + consonant (e.g., up)
Produces syllable shape CVC - consonant + vowel + consonant (e.g., mom, dad)
Produces syllable shape CVCV - consonant + vowel + consonant + vowel (e.g., mama, dada)
Language/Communication
Follows Instructions with 2 or 3 steps
Can name most familiar things
Understands words like "in", "on", and "under"
Says first name and age
Names a friend
Says words like "I," "me," "we," and "you" and some plurals (cars, dogs, cats)
Talks well enough for strangers to understand most of the time
Carries on a conversation using 2 to 3 sentences
Social/Emotional
Copies adults and friends
Shows affection for friends without prompting
Takes turns in games
Shows concern for a crying friend
Understands the idea of "mine" and "his" or "hers"
Shows a wide range of emotions
Separates easily from mom and dad
May get upset with major changes in routine
Dresses and undresses self
Cognitive (learning, thinking, problem-solving)
Can work toys with buttons, levers, and moving parts
Plays make-believe with dolls, animals, and people
Does puzzle with 3 or 4 pieces
Understands what "two" means
Copies a circle with pencil or crayon
Turns book pages one at a time
Builds towers of more than 6 blocks
Screws and unscrews jar lids or turns door handle
Additional Concerns/Information
Woo! You did it. You took the first step to better understanding your little one. I’m looking forward to our chat and discovering what strategies and supports will further help your little one blossom. For now, sit back and take a deep breath. We’ll be in touch soon! :) Thank you!