Developmental Screening Form

Let’s Check In on Your Child’s Development

At Dynamic Therapy Specialists, we hear this all the time from parents:
“I don’t know if something is wrong." or "I just want to make sure everything is on track.”

Parenting comes with a lot of questions. Sometimes it’s something specific, and sometimes it’s just a gut feeling that it might be helpful to pause and take a closer look.

This free developmental screener was created by our team of pediatric therapists to help families reflect and get a clearer picture of how their child is doing across key areas of development.

By completing this screener, you can:
- Gain insight into your child’s communication, social, learning, and developmental skills
- Feel more confident about what you’re noticing at home or hearing from teachers
- Get reassurance when things are on track — or clarity if questions remain
This screener is:

✅ Completely free
✅ Quick and easy to complete
✅ Non-committal

Whether you’re responding to teacher feedback, noticing changes at home, or simply trusting your intuition, this screener is here to help you feel informed, supported, and confident in your child's development.
Name of person completing registration form:

First NameLast Name
Child's Name:

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
How did you find our screening?
Child's Age:
Please check any skills your child is NOT yet doing consistently or that feel challenging:
Communication & Language Skills
Social & Emotional Skills
Sensory-Related Skills
Learning & Cognitive Skills
Motor & Daily Living Skills
Please check any skills your child is NOT yet doing consistently or that feel challenging:
Communication & Language Skills
Social & Emotional Skills
Sensory-Related Skills
Learning & Cognitive Skills
Motor & Daily Living Skills
Please check any skills your child is NOT yet doing consistently or that feel challenging:
Communication & Language Skills
Social & Emotional Skills
Sensory-Related Skills
Learning & Cognitive Skills
Motor & Daily Living Skills
Please check any skills your child is NOT yet doing consistently or that feel challenging:
Communication & Language Skills
Social & Emotional Development
Sensory-Related Skills
Learning & Cognitive Skills
Motor & Daily Living Skills
Please check any skills your child is NOT yet doing consistently or that feel challenging:
Communication & Language Skills
Social & Emotional Development
Sensory-Related Skills
Learning & Cognitive Skills
Motor & Daily Living Skills
Please check any skills your child is NOT yet doing consistently or that feel challenging:
Communication & Language Skills
Social & Emotional Development
Sensory Related Skills
Learning & Cognitive Skills
Motor & Daily Living Skills
Please check any skills your child is NOT yet doing consistently or that feel challenging:
Communication & Language Skills
Social & Emotional Skills
Sensory-Related Skills
Learning & Cognitive Skills
Motor & Daily Living Skills
Please check any skills your child is NOT yet doing consistently or that feel challenging:
Communication & Language Skills
Social & Emotional Skills
Sensory-Related Skills
Learning & Cognitive Skills
Motor & Daily Living Skills
Please check any skills your child is NOT yet doing consistently or that feel challenging:
Communication & Language
Social & Emotional Skills
Sensory-Related Skills
Learning & Cognitive Skills
Motor & Daily Living Skills
Please share any additional details or concerns you have about your child’s development.
Calculation for 12-18 months age group
Calculation for 18-24 months age group
Calculation for 2-3 years age group
Calculation for 3-4 years age group
Calculation for 4-5 years age group
Calculation for 5-6 years age group
Calculation for 6-7 years age group
Calculation for 7-8 years age group
Calculation for 8+ years age group
Should be Empty: