Email *

Child Date of Birth *

If they were premature, please identify their adjusted age. This assessment goes off of adjusted ages.

How would you describe your baby's muscle tone (how their body feels when you touch or hold them)?

Floppy/ Wet Noodle

Tight/Rigid

Somewhere in between

I feel comfortable leaving my baby in a sitting position when I leave the room.

True

False

When I think about my baby, or look at pictures of them, their head is usually tilted or rotated to the side. And now that I think about it, they may even have a little bit of a flat spot on their head.

Yes

It's hard to tell

No

My baby is able to move around easily on the floor through the following methods (there can me multiple choice)

Rolling

Army Crawling

Butt Scooting

A Funky Thing I can't Even Name

Hands and Knees

My baby is able to move between the floor and sitting on their own.

True

False

My baby is curious and is starting to get onto their knees to see what's on top of the table or couch.

True

False

My baby is starting to pull themselves up from the floor to a standing position.

True

False

My baby spends a lot of time 'contained' in a bouncer, jumper, walker, carseat, or in my arms.

True

False

When I hold my baby up in a standing position, they:

Lock out their knees and push their booty back

Stand on tiptoes

Jump nonstop

Stand upright on flat feet and sometimes even bounce

My baby has a clear side preference already (looking, reaching, pulling up to stand).

True

False

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