Information about your child’s Gross motor development in the first 2 years, e.g. age of walking independently, sitting, crawling.

Walking pattern

Does your child fall or trip often? Select Yes No

Is your child able to run? Select Yes No

If your child is running does it seem coordinated? Select Yes No

Does your child fatigue quickly? Select Yes No

Do you see any asymmetry while walking, e.g. one leg is dragged? Select Yes No

Does you child walk quietly or with a loud stomping sound? Select Yes No

How long is your child able to walk continuously without needing a break?

Does your child use equipment to assist mobility? (e.g.: orthotics, AFO, walking frame,wheelchair). If yes, who is your supplier?

Has your child had any other physiotherapy or motor assessments?

What are your concerns about your child’s development?

Any other information you feel would help in your child’s assessment