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36 Month Questionnaire 34 months 16 days through 38 months 30 days Important Points to Remember: Try each activity with your baby before marking a response. Make completing this questionnaire a game that is fun for you and your child. Make sure your child is rested and fed. Please return this questionnaire by _____. Notes:
36 Month Questionnaire 34 months 16 days through 38 months 30 days Important Points to Remember: Try each activity with your baby before marking a response. Make completing this questionnaire a game that is fun for you and your child. Make sure your child is rested and fed. Please return this questionnaire by _____. Notes:
Ages & Stages Questionnaires®, Third Edition (ASQ-3™),Squires & Bricker © 2009 Paul H. Brookes Publishing Co. All rights reserved. 36 Month Questionnaire page 6 of 7 E101360600 OVERALL Parents and providers may use the space below for additional comments. 1. Do you think your child hears well? If no, explain: 2.
Gives one-word answers to questions. Imitates many new words. Uses words of more than one syllable with meaning (“bottle”). Speaks 10 to 20 words. Understands simple “yes/no” questions.
15–20 hours per week with the child should complete ASQ:SE-2. Answer questions based on what you know about your child’s behavior. Answer questions based on your child’s usual behavior, not behavior when your child is sick, very tired, or hungry. 36 Month Questionnaire 33 months 0 days through 41 months 30 days
Thank you and please look forward to filling out another ASQ:SE questionnaire in months. Please provide the following information. What is your relationship to the child? 1. 10. Is your child interested in things around him, 18. Does your child follow routine directions? For example, does she come to the table or help clean up her toys when asked?
36 Month Questionnaire 34 months 16 days through 38 months 30 days Important Points to Remember: Try each activity with your child before marking a response. Make completing this questionnaire a game that is fun for you and your child. Make sure your child is rested and fed. Please return this questionnaire by _____.