Well Child Visits: Bright Futures forms and Vacci

Welcome.  We want you to have an efficient, low-stress visit where you can focus on your child's development, and have the time to ask about your concerns.  Here are the forms that we use at well child visits—please print and complete them at home and bring them to your check-up.

Forms we use:

Bright Futures: This is a national health promotion and disease prevention toolkit that is supported by the AAP. Each visit has an age-appropriate pre-visit questionnaire, and information handouts that you will receive after your Well Baby visit. You will notice the questions focus on developmental milestones, nutrition, safety, your child and family’s emotional well-being, and recommendations from the AAP. Time to complete: 2 minutes

Edinburgh: This tool was developed to screen for depression in pregnant and postpartum mothers. Time to complete: 2 minutes

ASQ (Ages and Stages Questionnaire): This is regarded as the best developmental and social-emotional screening tool for children from one month to 5 ½ years. Since it is parent-completed, it incorporates your expert knowledge of your own children. Printing this and completing it at home gives you time to really observe your child and record his/her abilities accurately. Time to complete: approx. 5 minutes

M-CHAT: Modified Checklist for Autism in Toddlers, starting at 18 and 30 months.  Time to complete 1 minute