Number of Pages: 9
 
Who is it for?
New client
 
What is it for?
A questionnaire to be filled out by guardian for intake
Form includes the following sections:
Medical and psychological history
Educational history 
Child's strengths and challenges
Child's current level of performance in:
Language and communication
Social-communication skills
Other areas: motor, eating, dressing, grooming, hygiene, writing, reading, math
Family Priorities & Preferences
 
Why should you use it?
To gather information about the client as part of the intake process
To gather information about the client's skills and needs
Highly recommend to use it as part of the Intake Packet 
 
Disclaimer/Recommendations: 
While this intake questionnaire has sections where guardian can share with provider the skill level of the client, this questionnaire is not intended to replace any assessments.