The questionnaires below will help your physician to better understand your child's health care needs. Please take a moment and complete the appropriate questionnaire and bring this with you to your child's appointment.

Health Habits Survey
(Complete for all Well Child Visits from ages 2 to 24 years)

• Your Child's Health Habits [PDF, 294KB]
  We are interested in the health and well-being of all our patients. Please take a moment to answer these questions about your child's health habits.

Autism Spectrum Disorders (ASD)
(Complete for 18 and 24 month Well Child Visits)

• M-CHAT Test [PDF, 37.4KB]
  The M-CHAT is validated for screening toddlers between 16 and 30 months of age, to assess risk for autism spectrum disorders (ASD). The M-CHAT can be administered and scored as part of a well-child check-up, and also can be used by specialists or other professionals to assess risk for ASD.

Attention Deficit Hyperactivity Disorder (ADHD)
There is no specific test for ADHD. Gathering as much information as possible about your child is the best way to get an accurate diagnosis and rule out other possible causes of your child's symptoms.

Parent and Teacher Questionnaires

• NICHQ Vanderbilt Assessment Scale: Parent Informant [PDF, 104KB]

• NICHQ Vanderbilt Assessment Follow-Up: Parent Informant [PDF, 188KB]

• NICHQ Vanderbilt Assessment Scale: Teacher Informant [PDF, 188KB]

• NICHQ Vanderbilt Assessment Follow-Up: Teacher Informant [PDF, 189KB]

Asthma

• Asthma Control Test [PDF, 116KB]
  This test will provide a score that may help your doctor determine if your child’s asthma treatment plan is working or if it might be time for a change.