We ask that you fill in this form and return it to us prior to your childs appointment 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your child's information, including their name, address, date of birth, age, gender, grade, and school name. This information is crucial for tailoring the assessment.
3. Next, provide details about the parent or guardian. Fill in names, emails, phone numbers, and preferred communication methods for both guardians.
4. In the 'Primary areas of concern' section, clearly outline what you hope the Occupational Therapist will address during the assessment.
5. Complete the medical history section by checking any relevant conditions your child has experienced. This helps in understanding their background.
6. Fill out developmental history by noting when key milestones were achieved. If there are any concerns regarding motor development, please specify.
7. Continue with hearing and vision assessments by answering questions related to tests and results.
8. Lastly, provide insights into behavior and social skills as well as sensory status by indicating if any statements apply to your child.

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