Preschool/El Questionnaire

Tri-State Developmental Pediatrics

Please correct the errors described below.

Your student has been referred to Tri-State Developmental Pediatrics for evaluation or treatment. Thank you in advance for completing the following form. Information and input from your team is very important to us! Diagnostic and treatment decisions rely on an understanding of a child’s functioning in a variety of settings. We also rely heavily on EI and preschool testing. We do not repeat any testing that is completed at school. Before scheduling a child’s evaluation, we ask the family to collect educational records and appreciate when schools make these records available to families.

Child Information

Current Programming

Please provide information about the child’s current programming (mark all that apply).

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