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Speech & Occupational Therapy of North Texas

Clinic Locations in Frisco, McKinney & Plano – and Serving the Surrounding Communities.

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Speech & OT

Speech & Occupational Therapy of North Texas

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Child Development
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Home
About
Patient Dashboard
Pay Online
Child Development
Helpful Information
Contact Us

Speech & OT Survey

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Speech & OT Survey

Speech, Language and Fine Motor Survey

One of our Speech & Language Pathologists or Occupational Therapists will be happy to discuss your survey results with you. Complete the following survey questions, including the Contact Information, and a Licensed Therapist will contact you.

If you are a human and are seeing this field, please leave it blank.

Fields marked with a * are required

By the age of 12 months

Is your child understanding the meaning of familiar functional words?

Yes
No

Can your child understand language associated with daily routines, such as eating and bedtime?

Yes
No

Is your child babbling with consonant and vowel combinations?

Yes
No

Is your child imitating sounds made by others?

Yes
No

Is your child pointing with the index finger?

Yes
No

Can your child scoop up small objects such as Cheerios?

Yes
No

By the age of 24 months

Is your child producing first words?

Yes
No

Is your child able to follow a variety of basic directions?

Yes
No

Is your child able to recognize common objects and their uses?

Yes
No

Is your child using at least 100 words?

Yes
No

Is your child demonstrating rapid speech development?

Yes
No

Can your child hold a crayon with the whole hand and thumb up?

Yes
No

Can your child put on and take off his or her shoes, socks and shorts?

Yes
No

Can your child draw a vertical line?

Yes
No

By the age of 36 months

Is your child using more words daily and putting words together to expand on their meaning?

Yes
No

Is your child able to use sentences of 3-4 words?

Yes
No

Is your child using 300 to 500 words?

Yes
No

Is your child able to follow a series of 2 - 3 directions?

Yes
No

Can your child use speech that is 80% understandable?

Yes
No

Can your child string large beads?

Yes
No

Can your child snip paper with scissors?

Yes
No

Can your child roll clay into a snake?

Yes
No

Can your child draw a horizontal line?

Yes
No

Can your child complete simple puzzles?

Yes
No

Can your child build a tower of 9 blocks?

Yes
No

Can your child dress and undress independently?

Yes
No

From the ages of 48 to 60 months

Is your child using approximately 600 to 1600 words?

Yes
No

Is your child talking about recent events and experiences?

Yes
No

Is your child using sentences of increasing length and complexity?

Yes
No

Is your child 100% understandable?

Yes
No

Has your child developed more complex speech sounds, such as consonant blends?

Yes
No

Can your child pour his or her own drink?

Yes
No

Can your child string small beads?

Yes
No

Can your child hold a pencil properly?

Yes
No

Can your child use scissors to follow and cut a straight or curved line?

Yes
No

Can your child manage buttons, zippers and snaps?

Yes
No

Can your child draw a cross?

Yes
No

Do you wish to discuss this survey with one of our specialists? Check YES below and one of our specialists will contact you as quickly as we can.

Yes
No

Name *

Phone

Email *

Child's Name

Child's Age

Locations

Plano Clinic Location

1410 14th Street
Plano, Texas 75074
Phone (972)424-0148
Fax (972)422-5275

Frisco Clinic Location

3880 Parkwood Blvd, Building 5, Suite 502
Frisco, Texas 75034
Phone (972)424-0148

McKinney Clinic Location

2240 Bush Drive, Suite 200
McKinney, Texas 75070
Phone (972)424-0148