General Information
Child's Name
Date of Birth
Parent/Guardian Name(s)
Contact Information
Can you describe your child's behavior, abilities, and challenges before joining our foundation?
Communication and Social Interaction
Has your child's verbal communication improved over the past three months? Please describe.
Is your child using more non-verbal communication (e.g: gestures, sign language)? If yes, provide examples.
How well is your child following and understanding verbal instructions?
How does your child interact with peers and adults? Any changes noticed?
Is your child engaging in more cooperative play with peers? Please describe.
Does your child show more interest in making friends or socializing?
Does your child initiate play with peers? Please describe.
Behavioral, Adaptive, and Learning Skills
Have there been any changes in your child's challenging behaviors (e.g: tantrums or aggression)? If yes, please describe.
What situations or stimuli seem to trigger these behaviors?
Which behavior management strategies (verbal praise, stickers, redirection, quiet time) have been effective?
For children and young adults aged 4-25, have you noticed any improvements in your child's daily living skills (e.g: dressing, feeding, toileting)? Please describe.
How well does your child follow routines and transitions between activities?
Does your child notice and respond to what's happening around them? If yes, please describe.
Have you noticed any progress in your child's learning or thinking skills? Please provide examples.
Is your child more engaged during learning activities?
Have there been any changes in your child's sensory preferences or sensitivities (e.g sound, smell, touch, taste)? Please provide examples.
How is your child's overall health?
If your child has been taking any prescribed supplements, have you noticed any improvements? If your child is not taking supplements, please skip this question.
Any new health concerns?
If your child has been receiving physiotherapy, have you noticed any improvements? If your child is not undergoing physiotherapy, please skip the question.
If your child has been following a prescribed diet plan, have you noticed any improvement? If yes, please describe. If your child is not on a diet plan, kindly skip this question.
How do you feel about the therapy your child has received in the past three months? Would you say it is satisfactory, excellent, or exceptional?
Are there any new challenges or concerns that have arisen in the past three months?
What additional support or resources do you think your child needs to continue progressing?