Ages & Stages Questionnaire for 9 Month Old

Northwest Suburban Pediatrics

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9 Month ASQ-3 Ages and Stages Questionnaires

9 months 0 days through 9 months 30 days 9 Month Questionnaire

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Baby's information

Person filling out questionnaire

Program Information

9 Month Questionnaire

On the following pages are questions about activities babies may do. Your baby may have already done some of the activities described here, and there may be some your baby has not begun doing yet. For each item, please select the circle that indicates whether your baby is doing the activity regularly (yes), sometimes, or not yet.

Important Points to Remember: 1. Try each activity with your baby before marking a response. 2. Make completing this questionnaire a game that is fun for you and your baby. 3. Make sure your baby is not tired or hungry. 4. Please bring this questionnaire with you to your baby’s health and development review.

COMMUNICATION

GROSS MOTOR

FINE MOTOR

* If Fine Motor Item 5 is marked “yes” or “sometimes,” mark Fine Motor Item 2 “yes.”

PROBLEM SOLVING

PERSONAL-SOCIAL

OVERALL

Parents and providers may use the space below for additional comments.

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