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K. Johns MedicalMedical & Behavioral Health

Screening · About 4 minutes

Developmental concerns questionnaire

For children age 5 and older, completed by a parent or guardian, when caregivers or schools raise developmental or learning questions.

About you

Please give at least a telephone number or an email address so the office can reach you.

About the child
Developmental history
Were early milestones such as walking and first words reached on time?*
Does your child have difficulty being understood by people outside the family?*
Does your child struggle with reading, writing, or math compared with classmates?*
Does your child have difficulty with back-and-forth conversation or play with peers?*
Does your child become very distressed by changes in routine?*
Does your child react strongly to sounds, textures, lights, or clothing?*
Does your child need more help than expected with dressing, hygiene, or self-care?*
Does your child have difficulty with coordination, handwriting, or physical activities?*
Services and school
Does your child have an IEP, 504 plan, or receive school services?*

Your responses are scored automatically when you submit. A score is not a diagnosis and is always reviewed by a clinician.

Submitting sends your answers directly to K. Johns Medical over an encrypted connection and creates a PDF for your clinician. It does not book an appointment and is not monitored in real time. For an urgent concern, call the office. In an emergency, call 911 or call or text 988.

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