Occupational Therapy Intake Form
To gain more information about how to best serve your child or young adult and family. HIPPA compliant and confidential personal history.
The dynamics between child and family members
Pregnancy & Birth
Previous Testing and Treatments
Sensory and Motor Development
Social-Emotional and Behavior Abilities
Adaptive and Self-Care
What are your goals for your child's program? What are the lagging skills? Be specific - what time of day, what environment?