/ Uncategorized / By vectorhealth Childcare Assessment Form Childcare Assessment Childs Name First Last Date of Birth MM slash DD slash YYYY Parent/ Guardian Name First Last PhoneEmail Gestational age at birth?Any complications during labour and delivery?Any issues/difficulties with first few months of life (approx. 6 months) (Colic, reflux, hospital stays, sicknesses, etc)?Do they have any other diagnosis or conditions?What concerns do you have regarding your child’s development at the present moment?How long have they had these difficulties/your concerns?Have you seen anyone for these concerns as of yet?Additional comments Signature
