Surveys, Forms & Questionnaires
Ages and Stages Questionnaires (ASQ)
The ASQ is a screening tool to identify developmental delays in infants and young
children during the crucial first 5 years of life. Parents complete a 30 item questionnaire
which asks about a child's progress in five key developmental areas – communication,
gross motor, fine motor, problem solving, and personal-social skills. The questionnaire
takes about 10 to 20 minutes to complete. Please bring your completed survey with
you to your visit with your child's pediatrician.
Ages and Stages Social-Emotional Questionnaires (ASQ:SE)
The ASQ:SE is a screening tool, meant to be used in conjunction with the ASQ, to
identify the need for further social and emotional behavior assessment in children
from ages 6 to 60 months.
Vanderbilt Index
A test used in the diagnosis and evaluation of children with ADHD.
Privacy Policy (HIPAA)
A detailed explanation of patient privacy rights The final page of the document
contains a form requiring a parents signature at the first office visit to denote
these policies were shared and understood.
Medical Record Release Form
You may use this form to request to have your child’s records transferred to our
office.
Financial Policy
A detailed explanation of Peds First Pediatrics Financial Policies. We have also
posted a series of Frequently Asked Questions on this topic within the
Insurance and Billing section of our website.