UPDOX - PATIENT PORTAL

Patient Name * Date of Birth *

Social and Emotional

1. Enjoys doing new things 2. Plays "Mom" and "Dad" 3. Is more and more creative with make-believe play 4. Would rather play with other children than by himself 5. Cooperates with other children 6. Often can't tell what's real and what's make-believe

Language/Communication

1. Knows some basic rules of grammar, such as correctly using "he" and "she" 2. Sings a song or says a poem from memory such as the "Itsy Bitsy Spider" or the "Wheels on the Bus" 3. Tells stories 4. Can say first and last name

Cognitive (learning, thinking, problem-solving)

1. Names some colors and some numbers 2. Understands the idea of counting 3. Starts to understand time 4. Remembers parts of a story 5. Understands the idea of "same" and "different" 6. Draws a person with 2 to 4 body parts 7. Uses scissors 8. Starts to copy some capital letters 9.Plays board or card games 10. Tells you what he thinks is going to happen next in a book

Movement/Physical Development

1.Hops and stands on one foot up to 2 seconds 2. Catches a bounced ball most of the time 3. Pours, cuts with supervision, and mashes own food Signature of Parent/Guardian *