Your Child’s Development History – details required ahead of your child’s assessment for speech and language difficulties

This information is essential for your child’s initial assessment.

Where you have answered yes to the questions, please explain and describe what you have observed and/or give examples in the space provided. Please provide as much detail as possible to help the speech and language therapist understand your child's difficulties. You may find your child’s 'My child’s personal health record' (red book) helpful when answering some of the questions.

Please be aware this form may take up to 20 minutes to complete. Incomplete forms will not be submitted.

To be completed by child's parent/carer

Are there any other languages spoken at home? *
Will you need an interpreter at any appointments we may offer? *

Current concerns

Birth history

Milestones and early development

When did you your child achieve the following? Please detail the year and month

Medical history

Family history

Socialisation / play