Occupational Therapy Evaluation Questionnaire - sldcenter 2026

1. Click ‘Get Form’ to open the Occupational Therapy Evaluation Questionnaire in the editor.
2. Begin by entering the child's name and today's date at the top of the form. This sets a clear context for your evaluation.
3. Fill in the parents' names, home phone number, emergency contact, school and grade, and date of birth. This information is crucial for identifying and contacting relevant parties.
4. List ages and relationships of individuals living with the child. This helps provide a comprehensive view of the child's environment.
5. Complete sections regarding diagnosis, referring physician, and reason for referral. Be as detailed as possible to ensure accurate assessment.
6. In the background information section, indicate any pregnancy complications and medications used during pregnancy. This historical context can be vital for therapy planning.
7. Rate your child's functioning in various areas on a scale from 1 to 4. Circle the appropriate number based on your observations.
8. Finally, list your child's strengths, weaknesses, therapy goals, and favorite activities to provide a holistic view that will guide therapeutic interventions.

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