2-Month Ages and Stages Questionnaire
Early developmental screening for infants at 2 months of age. Please answer all questions based on your child's current abilities.
Child's Full Name
*
First Name
Last Name
Child's Date of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Child's Gender
*
Male
Female
Other/Prefer not to say
Parent/Guardian Full Name
*
First Name
Last Name
Parent/Guardian Email Address
*
example@example.com
Communication Skills: Please indicate how often your child does the following.
*
Rows
Never
Sometimes
Often
Turns toward a familiar voice
1
2
3
Responds to sounds by making noises
4
5
6
Smiles in response to your smile
7
8
9
Gross Motor Skills: Please indicate how often your child does the following.
*
Rows
Never
Sometimes
Often
Lifts head when on tummy
10
11
12
Moves arms and legs equally well
13
14
15
Holds head up briefly during tummy time
16
17
18
Fine Motor Skills: Please indicate how often your child does the following.
*
Rows
Never
Sometimes
Often
Brings hands to mouth
19
20
21
Follows moving objects with eyes
22
23
24
Opens and closes hands
25
26
27
Problem Solving Skills: Please indicate how often your child does the following.
*
Rows
Never
Sometimes
Often
Looks at own hands
28
29
30
Watches faces closely
31
32
33
Responds to new sounds
34
35
36
Personal-Social Skills: Please indicate how often your child does the following.
*
Rows
Never
Sometimes
Often
Enjoys being held
37
38
39
Begins to smile at people
40
41
42
Calms down when comforted
43
44
45
Are there any concerns you would like to share about your child's development?
Submit Questionnaire
Should be Empty: