Initial Assessment FormPlease enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Childs Name *FirstLastDate of Birth *Parent(s)/Guardian(s) Name(s) *FirstLastEmail *Numbers *Parent(s)/Guardian(s) Name(s) FirstLastEmail NumbersEmergency Contact Details *FirstLastEmail Numbers *Home Address *Are there any medical conditions or allergies we should be aware of? *Does your child have any sensory sensitivities? (e.g., textures, sounds, smells) *Has your child received any previous assessments or diagnoses? If yes, please specify *Does your child take any medications? If so, please list: *How does your child primarily communicate? (e.g., speech, gestures, AAC device, Makaton, sign language) *What are some common words, phrases, or signs your child uses? *Does your child respond to their name? *Does your child initiate communication, or do they mostly respond when spoken to? *Is your child able to follow basic instructions (e.g., “sit down,” “give me”) *What are your child’s favorite toys, activities, or games? *Are there any specific characters, shows, or books your child loves? *What motivates your child (e.g., praise, stickers, specific toys)? *What are your child’s strengths? (e.g., problem-solving, creativity, motor skills) *What challenges does your child currently face? (e.g., social skills, attention span, learning difficulties) *Are there any particular behaviors or situations that concern you? *Does your child experience meltdowns or challenging behaviors? If so, what strategies help calm them? *Is your child currently attending school? If so, what type (e.g., mainstream, special education) *What subjects or activities does your child enjoy most at school? *How does your child interact with peers (e.g., playing, sharing, parallel play) * your struggle skills, Does your child struggle with transitions or changes in routine? If yes, what helps them adjust? *What does your child’s daily routine look like? *Does your child use any form of communication aids? (e.g., AAC device, picture cards, Makaton, sign language): *What are some challenges you experience at home (e.g., routines, behaviour, schoolwork)? *Are there specific goals you’d like to work on with your child? (e.g., improving communication, social skills, daily living skills) *What are your short-term goals for your child (e.g., improving communication, addressing behaviours)? *What are your long-term goals for your child (e.g., independence, social skills, academic progress)? *Picture permission for your child?YesNoSubmit
