Preferred Therapy Services

Checklists:

Physical Developmental Checklist

Click the box for each skill your child has mastered during that age. At the end of the form, please include your name, phone, and email address. One of our therapists will contact you within 24 hours with your child's results.

Click on the age periods to check the skills.

0 to 6 Months

When lying on back, kicks feet alternately
Head lags when pulled to sit
Turns head to both sides when on stomach
Lifts body with extended arms when on stomach
Rolls stomach to back (prone to supine)
Briefly holds head up in supported sit position

7 to 12 Months

Assumes hands and knees position (quadruped)
Sits unsupported for 30 seconds
Assists in pulling to standing from a seated position
Rolls from back to stomach
Crawls
Pulls self to stand
Cruises by holding on to furniture
Lowers self to floor from standing position

13 to 18 Months

Walks on own
Creeps up stairs
Raises self to standing position without help
Throws ball while standing

19 to 24 Months

Jumps in place
On stairs, uses a step-together pattern with rail support and one hand held

2 to 3 Years

Jumps from bottom step
Goes up and down stairs in a step-together pattern with rail support
kicks ball
Uses pedals on a tricycle
Walks up stairs, alternating feet with rail support
Walks with reciprocal arm swing
Runs

3 to 4 Years

Catches a large ball when thrown
When swinging attempts to pump legs
Walks down stairs with rail support
Rides tricycle 10 feet
Walks up stairs, alternating feeth with no rail support
Hops on one foot three times in a row
Uses language to express emotion

4 to 5 Years

Performs a somersault
Hits a target when throwing a ball
Stands on one foot for five seconds
Swings independently after a given push

Please summarize your child's physical abilities and/or concerns you may have. Please include your name and telephone number.



Full name*:
Phone*:
Email*:

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