SPEECH-LANGUAGE QUESTIONNAIRE. Child s Date of Birth. Phone (work/cell) (home) address. Home address. Referral Source. Diagnosis? Medications?
|
|
|
- Baldric Chase
- 7 years ago
- Views:
Transcription
1 Beennool lieel l Sppeeeecch aannd LLaanngguuaaggee,, PPLLLLCC th Ave N.E. Bellevue, WA (425) SPEECH-LANGUAGE QUESTIONNAIRE Child s Name Parents Phone (work/cell) (home) Today s Date Child s Date of Birth Age address Home address Siblings: Age Age Age Age Referral Source Diagnosis? Medications? Primary / Home language Is your child in a day care, infant program, preschool or school? If so, where, what grade and how many days per week? Please answer the following: 1. Describe your concerns: 2. When did you first notice the problem?
2 3. Is there a family history of speech-language disorders? Please describe: 4. Would you describe your child as a quiet infant? 5. Did your child babble? At what age? 6. Did your child use a variety of sounds when babbling? Examples: 7. When did your child say first words? 8. What were your child s first words? 9. When did your child combine two words? 10. How many words does your child use now? Does your child produce phrases and sentences? 2-word 3-word 4-word 5-word more 12. Does your child have difficulty making some consonant/speech sounds? If so, please list them: 13. Does your child prefer to communicate by using gestures or by pointing? 14. Does your child ever become frustrated when trying to speak or communicate his/her needs? Please explain. What helps your child reduce frustration? 15. Does your child have a history of using words once and never again? 16. Does your child play and communicate well with friends and family? 17. Can others outside the family understand your child when s/he speaks? 18. When did your child: crawl walk 19. Does your child have a history of: ear infections? How often? allergies? What kind? asthma? How severe? 20. Has your child ever had: surgery? Type and date? 2
3 chronic illness Type and date? serious accident? Type and date? 21. Did you have a normal pregnancy and delivery? Please explain: 22. Was the pregnancy full term? 23. What was your child s condition at birth? 24. Were there any feeding difficulties immediately after birth? 25. Did your child have any special needs after birth? 26. Does your child eat a variety of foods? Examples: 27. Does s/he avoid any specific type of food or texture (e.g., crunchy, creamy)? 28. Does your child drink from a cup? 29. When did your child start eating solid foods? 30. Did s/he have difficulty moving from liquids to solids? 31. Does your child choke or cough often when eating or drinking? 32. Does your child overstuff his/her mouth when eating? 33. Is s/he a messy/neat eater? 34. Is s/he bothered by a messy face? 35. Does your child resist/enjoy face washing? 36. Does your child resist/enjoy tooth brushing? 37. Does your child put objects in his/her mouth frequently? Examples: 38. Does you child suck his/her thumb or use a pacifier? 3
4 39. Does your child drool? 40. Can your child blow soap bubbles or blow out a candle? 41. Does you child have difficulty learning motor tasks (e.g., running, jumping, hopping, coloring, holding a spoon)? 42. Does your child seem clumsy? 43. Can your child follow simple directions? Complex directions? 44. If your child speaks in sentences, does s/he use correct grammar? Does s/he use first and second pronouns (I, me, my, you, your, yours) 45. Does your child imitate words? Actions? Does s/he imitate more single words, phrases, or both? 46. Does s/he generate new word combinations or mostly phrases s/he has heard and memorized? 47. Does your child ever use the right phrase but in the wrong situation (please instead of thank you, hi instead of bye.) 48. Does your child request help when needed? How? 49. Does your child tolerate: loud noises dirty/sticky hands socks and shoes water on the face tags in clothes 50. How would you describe your child s response to pain? (high pain tolerance, average, quick to cry, seeks sympathy.) 51. Does it ever seem like your child is not attending to your words (selective listening?) 52. Does your child comment on environmental noises (cars, airplanes, clock ticking, people in another room?) Are these noises distracting to your child? 53. Does your child prefer organization? Routine? Explain: 54. How would you describe your child s memory? poor average amazing 4
5 55. Does your child have any strong interests? (e.g., trains, space, sea life, a certain color) 56. Has your child ever had a hearing evaluation? Date: Results: 57. Has your child had a previous speech and language evaluation? Date: Who completed the evaluation? 58. Has your child ever been enrolled in speech-language therapy? Dates: Goals: 59. Has your child ever been enrolled in physical or occupational therapy? Dates: Goals: 60. Is there any other information about your child that you feel is important for us to know? 5
SPEECH AND LANGUAGE CASE HISTORY FORM PLEASE ATTACH A RECENT PHOTO OF YOUR CHILD HERE IDENTIFYING INFORMATION
SPEECH AND LANGUAGE CASE HISTORY FORM Date Person filling out this questionnaire Relationship to child PLEASE ATTACH A RECENT PHOTO OF YOUR CHILD HERE IDENTIFYING INFORMATION Name of child Nickname Date
Speech and Language Questionnaire for Children: Ages 0-3
Speech and Language Questionnaire for Children: Ages 0-3 Child s Name: Date of Birth: Name of Person Completing this Form: Relationship to Child: Today s Date: Whom should we thank for referring you to
PEDIATRIC - CASE HISTORY FORM
Thank you, for choosing Access Rehab Centers. We kindly request that you fill out all the necessary information for our therapists to complete a comprehensive evaluation of your child. Please mail this
INTAKE FORM - CHILD. Name: DOB: Age: Medical Diagnoses (of any kind): Educational Diagnoses: Reason for evaluation Parental concerns:
Providing services in: Physical Therapy Occupational Therapy Speech/Language Pathology Hydrotherapy Special Therapy Programs INTAKE FORM - CHILD Date: Name: DOB: Age: Medical Diagnoses (of any kind): Educational
SPEECH AND LANGUAGE EVALUATION CLIENT : RESP. PARTY : ADDRESS : INFORMANT : REFERRAL SOURCE : BIRTH DATE : EVALUATION DATE : PHONE : REPORT DATE :
(Leave room for letterhead) SPEECH AND LANGUAGE EVALUATION CLIENT : RESP. PARTY : ADDRESS : INFORMANT : REFERRAL SOURCE : BIRTH DATE : EVALUATION DATE : PHONE : REPORT DATE : All pages following the letterhead
www.amyspeechlanguagetherapy.com
Amy Reinstein, M.S., CCC SLP Speech Language Pathologist Amy Reinstein Speech & Language Therapy, Inc., 442 East 75 th Street, New York, NY 10021 Phone: 845-893-4232 Fax: 646-3305299 E-mail: AmyReinsteinSLP@gmail.com
The Arbor School of Central Florida Medical/Emergency Information Please Print
Student's Name: Student s Date of Birth: Student's Address: Student's Home Phone: Primary Medical Diagnosis: The Arbor School of Central Florida Medical/Emergency Information Please Print Mothers Name:
MULTIDISCIPLINARY PEDIATRIC FEEDING PROGRAM SCREENING QUESTIONNAIRE QUESTIONNAIRE PAGE OF
Today s Date: MULTIDISCIPLINARY PEDIATRIC FEEDING PROGRAM BACKGROUND INFORMATION 1. Child s 2. Date of Birth: / / 3. Gender: Male Female 4. Parent/Guardian(s) Name(s): 5. Marital Status: Married Single
ATLANTA SPEECH SCHOOL 3160 NORTHSIDE PARKWAY, NW ATLANTA, GA 30327 404-233-5332 APPLICATION AND CASE HISTORY QUESTIONNAIRE SUMMER PROGRAMS
ATLANTA SPEECH SCHOOL 3160 RTHSIDE PARKWAY, NW ATLANTA, GA 30327 404-233-5332 APPLICATION AND CASE HISTORY QUESTIONNAIRE SUMMER PROGRAMS DATE: CHILD S NAME: BIRTH DATE: S. S. # PARENTS: ADDRESS: TELEPHONE:
PARENT/CARER QUESTIONNAIRE 0 18 months
PARENT/CARER QUESTIONNAIRE 0 18 months We appreciate the time taken to complete this questionnaire, which allows us to gain vital information regarding your child s development. This information will be
Dymond Speech & Rehab., P.A. Patient Registration Information
Dymond Speech & Rehab., P.A. Patient Registration Information Client s Name: First Middle Last Street Address: Mailing Address: City : State: Zip code: Sex: Home Phone: ( ) - Cell: ( ) - Other: ( ) - of
Tennessee State University Department of Speech Pathology & Audiology Intensive Articulation, Fluency, Language & Diagnostics Summer Speech Camp
Tennessee State University Department of Speech Pathology & Audiology Intensive Articulation, Fluency, Language & Diagnostics Summer Speech Camp Speech Pathology and Audiology will provide intensive therapeutic
Become Independent with Daily Routines
Teaching Your Child to: Become Independent with Daily Routines Does this Sound Familiar? Nadine is a single mom with two young children ages 3 and 5. Her children attend preschool while she is working.
Infant Development: The First Year of Life
Infant Development: The First Year of Life Your child's first few years are critical in the development of his or her temperament, learning style and pattern of growth. You are your child's first and most
CLEFT PALATE HISTORY FORM
Harry Jersig Center 411 S.W. 24 th Street San Antonio, TX 78207 (210) 431-3938 CLEFT PALATE HISTORY FORM Child s name: Age: DOB: / / Parent/guardian name: Address: City/Zip code: Gender: Height: Weight:
Pediatric Speech-Language and Language Therapy Pediatric Occupational Therapy DIR /Floortime Therapy
Pediatric Speech-Language and Language Therapy Pediatric Occupational Therapy DIR /Floortime Therapy Thank you for your interest in our speech and language/occupational therapy and DIR Floortime services.
Portage Guide Birth to Six Preschool Indicator 7 Child Outcomes Crosswalk. Outcome 2 Acquisition & Use of Knowledge & Skills
Portage Guide Birth to Six Preschool Indicator 7 Child Outcomes Crosswalk NPG Domains Outcome 1 Positive Social Emotional Skills Outcome 2 Acquisition & Use of Knowledge & Skills Outcome 3 Appropriate
Developmental Pediatrics of Central Jersey
PATIENT INFORMATION: CLIENT INFORMATION Date: SS# Name: (Last) (First) (M.I.) Birthdate: Sex: Race: Address: City: State: Zip: Phone: (Home) (Work) (Cell) Which telephone number is preferred: ( ) Home
Dear Parents: We appreciate the opportunity to work with your child and look forward to getting to know your family. Sincerely,
Dear Parents: Thank you for considering Mobile Therapy Centers of America, LLC (MTC) for your child s therapy needs. At MTC, we strive to provide the highest quality of therapeutic intervention. Our services
Teaching Strategies GOLD Objectives for Development & Learning: Birth Through Kindergarten
Assessment Alignment of Teaching Strategies GOLD Objectives for Development & Learning: Birth Through Kindergarten with Alignment of the School Readiness Goals for Infants and in Head Start and Early Head
DEVELOPMENTAL SPEECH AND LANGUAGE HISTORY
DEVELOPMENTAL SPEECH AND LANGUAGE HISTORY Parents: This history may appear to be quite long. However, a number of the questions require checking off responses, which can be done quickly. This information
Last name: State/ Province: Home telephone number:
54 Ages & Stages Questionnaires 51 months 0 days through 56 months 30 days Month Questionnaire Please provide the following information. Use black or blue ink only and print legibly when completing this
SOCIAL AND DEVELOPMENTAL HISTORY. School Attending: Grade: Date of Birth: Telephone: Home: Work: Cell:
SOCIAL AND DEVELOPMENTAL HISTORY Student s Name: First Middle Last Male Female School Attending: Grade: Date of Birth: Parent s Names: Address: Telephone: Home: Work: Cell: Parent email address: Legal
How Early Can Autism Spectrum Disorder Be Diagnosed and Where To Focus Treatment for My Toddler. Tessa VanKirk, MS, BCBA Stormi Pulver White, PsyD
How Early Can Autism Spectrum Disorder Be Diagnosed and Where To Focus Treatment for My Toddler Tessa VanKirk, MS, BCBA Stormi Pulver White, PsyD What is Autism Spectrum Disorder (ASD)? Focus on 2 areas:
If child was born 3 or more weeks prematurely, # of weeks premature: Last name: State/ Province: Home telephone number:
16 Ages & Stages Questionnaires 15 months 0 days through 16 months 30 days Month Questionnaire Please provide the following information. Use black or blue ink only and print legibly when completing this
Talk To Your Baby Quiz
Talk To Your Baby Quiz 1. When should you start talking to babies? a) From the moment they are born b) After six weeks c) When they smile at you 2. When does the majority of brain development occur in
James is a five year old boy and spends his days at the. spends time with each individually. One of activities James loves is to sit down on the
Sarah Neuhalfen Case Study Child Development May 12, 2006 James is a five year old boy and spends his days at the Manchester Early Learning Center. He is the average size for his age and has blond hair
Parent Handouts: Language Intervention Activities
Parent Handouts: Language Intervention Activities 12 Preverbal-Preintentional General Language Strategies Learning to Talk Children learn to talk by hearing others talk to them. You can help your child
Female Child s date of birth: Last name: State/ Province: Home telephone number:
60 Ages & Stages Questionnaires 57 months 0 days through 66 months 0 days Month Questionnaire Please provide the following information. Use black or blue ink only and print legibly when completing this
PATIENT INFORMATION ALLERGIES
PATIENT INFORMATION Patient Name: Sex: Male Female Last First Middle Nickname: Child s Social Security (SS) #: Date of Birth: Parent/Legal Guardian: Relationship: SS#: Parent/Legal Guardian: Relationship:
Schreiber Pediatric Rehab Center Portable Medical Profile
I. Demographic Information Schreiber Pediatric Rehab Center Portable Medical Profile A. Client DOB II. Family Composition and History A. Please list all people living with the child in your home. Name
everyday s a learning day
everyday s a learning day Birth to 3 years Health and Wellbeing, Literacy and Numeracy Give your Child a Great Start Every Day s a Learning Day Page 2 c SThis book for parents and carers of children aged
Last name: State/ Province: Home telephone number:
60 Ages & Stages Questionnaires 57 months 0 days through 66 months 0 days Month Questionnaire Please provide the following information. Use black or blue ink only and print legibly when completing this
Female Child s date of birth: Last name: State/ Province: Home telephone number:
27 Ages & Stages Questionnaires 25 months 16 days through 28 months 15 days Month Questionnaire Please provide the following information. Use black or blue ink only and print legibly when completing this
Learn the steps to identify pediatric muscle weakness and signs of neuromuscular disease.
Learn the steps to identify pediatric muscle weakness and signs of neuromuscular disease. Guide for therapists/specialists Questions and comments to: info@childmuscleweakness.org Surveillance and Referral
Case Study Child Development Kelsey Heisler May 6, 2009
Case Study Child Development Kelsey Heisler May 6, 2009 This case study is on a young girl named Hannah. She was observed in a classroom at the Early Learning Center. She is 4 years old. She is the only
Occupational Therapy Handout
Occupational Therapy Handout SENSORY STRATEGIES FOR PARENTS Reacting to different sensations and activities Different children notice and respond to different things from the world around them. Your child
Nikki White Children s Occupational Therapist Barnet Community Services
Nikki White Children s Occupational Therapist Barnet Community Services What is Occupational Therapy (OT)? An occupation is anything you do in your daily life. Anything meaningful or purposeful Eg. Getting
The Burning Bush Lesson Aim: To know God speaks to us.
Teacher s Guide: Ages 4-5 God of Wonders Part 2: Genesis through Joshua Unit 8, Lesson 40 The Burning Bush Lesson Aim: To know God speaks to us. THE WORSHIP Who God is: The God Who Speaks THE WORD Bible
Physical, Occupational, Speech & Developmental Therapy
Physical, Occupational, Speech & Developmental Therapy Let me begin by saying thank you for choosing Allied Therapy and Consulting Services as your child s therapy provider. We hope to make this a smooth
Preschool Learning Center
Preschool Learning Center GUIDELINES AND INFORMATION ON FEEDING AND SAFE MEALTIME PRACTICES FOR STUDENTS IN A SCHOOL SETTING I. RATIONALE FOR FEEDING GUIDELINES The number of children with severe disabilities
AGES & STAGES QUESTIONNAIRES : SOCIAL-EMOTIONAL
Version 1.1 AGES & STAGES QUESTIONNAIRES : SOCIAL-EMOTIONAL A PARENT-COMPLETED, CHILD-MONITORING SYSTEM FOR SOCIAL-EMOTIONAL BEHAVIORS by Jane Squires, Ph.D. Diane Bricker, Ph.D. and Elizabeth Twombly,
All About Me. Babies (0-1) Meal times. Has your baby been weaned? Yes No
All About Me To make the transition from home to Early Learners Nursery School as smooth as possible, could you give us the information about the following areas: Babies (0-1) Meal times Has your baby
DOMAIN Ill: Cognitive Development
Purpose: To develop new skills, knowledge and the ability to acquire and process new information through play and interaction with others and the environment. The cognitive development domain includes
Purpose: To develop physical and motor skills and promote health and well-being
Purpose: To develop physical and motor skills and promote health and well-being The physical and motor development domain includes the physical and motor skills and abilities that emerge during the infant
NEUROPSYCHOLOGY QUESTIONNAIRE. (Please fill this out prior to your appointment and bring it with you.) Name: Date of appointment: Home address:
NEUROPSYCHOLOGY QUESTIONNAIRE (Please fill this out prior to your appointment and bring it with you.) Name: Date of appointment: Date of birth: Age: _ Home address: _ Home phone: Cell phone: Work phone:
Hopeful Lutheran Preschool 2 & 3 Year Old Daily Routine
Hopeful Lutheran Preschool 2 & 3 Year Old Daily Routine 9:00 9:25 Free Choice Children choose any activity he/she wishes. (art center, dramatic play center, science center, etc.) 9:25 9:40 Bible Time Pledge
Purpose: To acquire language and the ability to communicate successfully with others
Purpose: To acquire language and the ability to communicate successfully with others The language development and communication domain involves the development of the ability to use language to communicate
Getting Started with the Verbal Behavior. Approach EDUCATION & THERAPIES RN, MSN, BCBA
Getting Started with the Verbal Behavior BY Mary Lynch Barbera, RN, MSN, BCBA Approach Mary Lynch Barbera, RN, MSN, BCBA offers a unique perspective as both a parent of a child with autism, as well as
Thomas L. Layton, Ph.D.
Developmental Scale for Children with Down Syndrome Thomas L. Layton, Ph.D. Extraordinary Learning Foundation T and T Communication Services, Inc. 100 Meredith Drive, Suite 100 Durham, NC 27713 Developmental
Speech & Swallowing The ba sic fac t s
Speech & Swallowing The ba sic fac t s Multiple sclerosis If people are asking you to repeat words; if it s getting harder to carry on conversations because your speech is slurred, slow, or quiet; if you
PARTNERS IN PEDIATRIC CARE. Intake and History for Mental Health Referral
PARTNERS IN PEDIATRIC CARE Intake and History for Mental Health Referral This form is designed to give you an opportunity to provide us with background information that will help us help you. Please read
FIT Child Development Audio Conference Journal Date: March 10, 2010 Topic: 24 30 months Participants: 6 New information:
FIT Child Development Audio Conference Journal Date: March 10, 2010 Topic: 24 30 months Participants: 6 New information: ~ In the area of gross motor/movement development, babies are, with support, walking
CHILD S FACE SHEET/ENROLLMENT FORM INFANT/TODDLER
CHILD S FACE SHEET/ENROLLMENT FORM INFANT/TODDLER CHILD INFORMATION: Child s Name: Date of Birth Home Address: Place of Birth:(city/town) Telephone: Primary Language: Child s Identifying Information (required
Behavioral and Developmental Referral Center
Dear Parent, Thank you for allowing us the opportunity to serve your family. We will make every effort to best meet your needs. You will find a brief questionnaire enclosed with this letter. This information
Early Intervention 101
Early Intervention 101 WHAT SHOULD YOU TAKE FROM THIS PRESENTATION? Learning Objectives By the end of this training, you will be able to: 1) Identify at least 2 effects of prenatal drug/alcohol exposure
Purpose: To approach the world with a sense of trust and emotional security
Purpose: To approach the world with a sense of trust and emotional security The social and emotional domain includes the development of trust and emotional security, self-awareness, self-regulation and
MODULE 4: Communication
MODULE 4: Communication Materials Flipchart paper, pens, toffees (or other chewy sweets), empty crisp packets, other items with different textures or sounds such as rattles, squeaky toys, ball, doll, cell
Child and Adolescent Developmental Questionnaire
Child and Adolescent Developmental Questionnaire Child s Name:. Age Date of Birth Person completing this form: Relationship: Sex: M / F Date: Current Problems What is the # 1 concern causing you to seek
GUIDELINES FOR WRITING FAMILY-CENTERED OUTCOMES
GUIDELINES FOR WRITING FAMILY-CENTERED OUTCOMES There has been much confusion regarding the writing of outcomes and goals following our previous EI trainings. In Virginia, outcomes and goals must be family-centered
Henry the Hand School Skit
Henry the Hand School Skit (We encourage the Facilitator to use an assembly program, preferably with multiple grade levels present. Kindergarten through 3 rd grades are most receptive and also very effective
Age Group: Children / Adolescents and Young Adults / Adults
INFORMATION SHEET Age Group: Children / Adolescents and Young Adults / Adults Sheet Title: Australian Scale for Diagnosis Asperger s Syndrome Foundation, The Kensington Charity Centre, 4th Floor, Charles
Growing Up With Epilepsy
Teaching Students with Epilepsy: Children with epilepsy often experience learning issues as a result of their seizures. These may include ongoing problems with motor skills or cognitive functions, as well
DEVELOPMENTAL CHECKLIST 1 TO 3 MONTHS (Revised as of 9/04)
DEVELOPMENTAL CHECKLIST 1 TO 3 MONTHS (Revised as of 9/04) MOVEMENT RAISES HEAD AND CHEST WHEN LYING ON STOMACH (3 MOS.) SUPPORTS UPPER BODY WITH ARMS WHEN LYING ON STOMACH (3 MOS.) STRETCHES LEGS OUT
AGES AND STAGES: BREASTFEEDING DURING YOUR BABY S FIRST YEAR
AGES AND STAGES: BREASTFEEDING DURING YOUR BABY S FIRST YEAR Adapted from Ages and Stages: What to Expect During Breastfeeding by Vicki Schmidt, RN, IBCLC BREASTFEEDING YOUR 1-2 MONTH OLD 2» Turn his head
Preschool Development Assessment
Preschool Development Assessment Child s Name: DOB: Completed by: Date began: This document may be copied for classroom use only. Not to be sold or used on any other website. Property of www.re-teach.com.
How to take care of your baby s teeth and gums
Children s Dental Health In This Issue: } How to take care of your baby s teeth and gums } How to keep your child s teeth healthy } Preparing Kids for Their First Dental Checkup How to take care of your
English/Sentence Skills Sample Test
English/Sentence Skills Sample Test There are 20 questions in total on this section. You will see two types of questions: sentence correction and construction shift. Sentence Correction These questions
Question Specifications for the Cognitive Test Protocol
Question Specifications for the Cognitive Test Protocol Core Questions These are the 6 disability questions to be tested in the interview. All of the other questions in the cognitive test protocol are
Speech- Language Pathologists in Your Child s School
Speech- Language Pathologists in Your Child s School What does the SLP do in schools? Screen students to find out if they need further speech and language testing. Evaluate speech and language skills.
www.icommunicatetherapy.com
icommuni cate SPEECH & COMMUNICATION THERAPY Milestones of speech, language and communication development 0-12 Months The rate of children's speech and language development can vary, depending on the child.
GROWING HEALTHY. A Guide for Head Start Health Managers and Families about Healthy Active Living for Young Children
GROWING HEALTHY A Guide for Head Start Health Managers and Families about Healthy Active Living for Young Children STAFF NOTES START TODAY HELP YOUR YOUNG CHILDREN STAY AT A HEALTHY WEIGHT FOR LIFE Why
RSV infection. Information about RSV and how you can reduce the risk of your infant developing a severe infection.
RSV infection Information about RSV and how you can reduce the risk of your infant developing a severe infection. What is RSV? RSV is one of the most common respiratory viruses and is spread easily. By
a guide to understanding moebius syndrome a publication of children s craniofacial association
a guide to understanding moebius syndrome a publication of children s craniofacial association a guide to understanding moebius syndrome this parent s guide to Moebius syndrome is designed to answer questions
Avon Seedlings Program 2015-2016 An Academic Preschool and Childcare Opportunity
Avon Seedlings Program 2015-2016 An Academic Preschool and Childcare Opportunity REGISTRATION FORM I hereby apply for enrollment of my child in the Avon Seedlings Program. Child s Gender: Date of Birth:
0 3 Months Sensory Motor Checklist
0 3 Months Sensory Motor Checklist Enjoys playful face-to-face interaction with people Coos in response to playful interaction Notices and responds to sounds Moves legs and arms off of surface when excited
Providing Support for Special Needs Children By The U.S. Department of Education, Office of Educational Research and Improvement. Posted June 1998.
Providing Support for Special Needs Children By The U.S. Department of Education, Office of Educational Research and Improvement. Posted June 1998. All children can succeed with the right support. Being
Modified Checklist for Autism in Toddlers (M-CHAT) Follow-Up Interview
Modified Checklist for Autism in Toddlers (M-CHAT) Follow-Up Interview **May be used for research or clinical purposes, but please do not cite or distribute** Acknowledgement: We thank Joaquin Fuentes,
Social Emotional Tips
Social Emotional Tips FOR Families with Toddlers Introduction The quality of each toddler s relationships with familiar adults especially their parents sets the foundation for social and emotional health.
ABOUT YOUR SCHOOL NURSING SERVICE
ABOUT YOUR SCHOOL NURSING SERVICE Welcome to Your School Nursing Service Now Your Child is at School When your child starts school the School Nursing Service takes over their care from the Health Visitor.
Produced in partnership by: Universally Speaking. The ages and stages of children s communication development from birth to 5
Produced in partnership by: Universally Speaking The ages and stages of children s communication development from birth to 5 Children can all be great communicators Communication is the way we connect
Expressive Objective: Realize the importance of using polite expressions in showing respect when communicating with others
QUARTER 4 - WEEK 1 Theme: My School and Friends TARGET SKILLS : At the end of the lesson the students should be able to: Expressive Objective: Realize the importance of using polite expressions in showing
Part Four: Who is Accompanying the Child Today? Part One: Tell Us About Your Child. Part Five: Referral. Part Six: Person Responsible for Account
Kee Kwak, DDS Grace E. Smart, DDS, MS, PC 2426 Beltline Road Garland, TX 75044 New Patient Health History Form Print this form, complete all information, and bring it with you on your first visit to our
Copyright 1999 by Paul H. Brookes Publishing Co.
Ages & Stages Questionnaires : A Parent-Completed, Child-Monitoring System Second Edition By Diane Bricker and Jane Squires with assistance from Linda Mounts, LaWanda Potter, Robert Nickel, Elizabeth Twombly,
Glen Davis PhD Maine Child Psychology 2 Elm Street, Waterville, ME 04901 Telephone: (207) 221-2631 Fax: (207) 221-3368 MaineChildPsych.
Dear Parent, Glen Davis PhD Maine Child Psychology 2 Elm Street, Waterville, ME 04901 Telephone: (207) 221-2631 Fax: (207) 221-3368 MaineChildPsych.com Thank you for your interest in psychological services
Tear Soup Cooking Tips Reprinted from Tear Soup, a recipe for healing after loss
Grandy s Cooking Tips Grief is the process you go through as you adjust to the loss of anything or anyone important in your life. The loss of a job, a move, divorce, death of someone you love, or a change
Pediatric Outpatient Rehabilitation Services
Pediatric Outpatient Rehabilitation Services Northwestern Medicine Pediatric Rehabilitation As a parent, you want your child to lead a full and satisfying life at home and in school. The goal of Pediatric
NEURO-OPHTHALMIC QUESTIONNAIRE NAME: AGE: DATE OF EXAM: CHART #: (Office Use Only)
PAGE 1 NEURO-OPHTHALMIC QUESTIONNAIRE NAME: AGE: DATE OF EXAM: CHART #: (Office Use Only) 1. What is the main problem that you are having? (If additional space is required, please use the back of this
2008 Greenville Speech & Language Therapy, PLLC
Greenville Speech & Language Therapy, PLLC ADULT PATIENT REGISTRATION FORM 18 YEARS AND OLDER PATIENT INFORMATION PATIENT S NAME: DATE OF BIRTH: _- _- SEX: MALE FEMALE SS#:_ - - ADDRESS: _ CITY: STATE:
Nutrition Therapy. ASD Brain Nutrition. HELP My Child Won t Eat! HELP My Child Won t Eat! Nutrients Critical for Brain Function
HELP My Child Won t Eat! HELP My Child Won t Eat! Elizabeth Strickland, MS, RD, LD PO Box 3297 Glen Rose, TX 76043 Telephone: (830) 237-2886 Fax: (866) 855-8301 Email: ASDpuzzle@aol.com Website: www.asdpuzzle.com
IMM 5738. Developmental milestones. Subject. Chart of early childhood development. Goal/Objective. Instructions. Additional Investigation
Developmental milestones Chart of early childhood development IMM 5738 Subject Instructions for evaluating and reporting of developmental milestones of infants as well as children and completing of the
The T-shirt named zee
The T-shirt named zee By: June St. Clair Atkinson shirt elementary June St. Clair Atkinson, Ed.D., State Superintendent 6301 Mail Service Center Raleigh, NC 27699-6301 Phone 919.807.3432 Fax 919.807.3445
Why and how to have end-of-life discussions with your patients:
Why and how to have end-of-life discussions with your patients: A guide with a suggested script and some basic questions to use The medical literature consistently shows that physicians can enhance end-of-life
EARLY CHILDHOOD MENTAL HEALTH CONSULTATION. Introduction
EARLY CHILDHOOD MENTAL HEALTH CONSULTATION Introduction Your baby s first year is an exciting time filled with wonderful new experiences.your interactions today are crucial to his/her long-term physical,
W. Daniel Williamson, M.D. and Anson J. Koshy, M.D. Developmental Pediatricians Dan L. Duncan Children s Neurodevelopmental Clinic Children s
W. Daniel Williamson, M.D. and Anson J. Koshy, M.D. Developmental Pediatricians Dan L. Duncan Children s Neurodevelopmental Clinic Children s Learning Institute University of Texas Health Science Center
Innovative Tools and Technology to use during Aural Rehabilitation Therapy
Innovative Tools and Technology to use during Aural Rehabilitation Therapy Jodi Creighton, M.S.,CCC-A,LSLS Cert. AVT Cincinnati Children s Hospital Medical Center As one parent I know said, You are not
Ages and Stages 48-60 Months
The Busy World of Your Preschooler: An Overview of Your Preschooler s Development Your preschooler is a pretty capable person by now. Four year olds are more even-tempered and cooperative with parents
GESE Initial steps. Guide for teachers, Grades 1 3. GESE Grade 1 Introduction
GESE Initial steps Guide for teachers, Grades 1 3 GESE Grade 1 Introduction cover photos: left and right Martin Dalton, middle Speak! Learning Centre Contents Contents What is Trinity College London?...3
EARLY CHILDHOOD TRANSITION PROCESS
FALL 2015 EARLY CHILDHOOD TRANSITION PROCESS A guide for helping families of children with special needs prepare for smooth and effective transitions JOHN WHITE STATE SUPERINTENDENT OF EDUCATION Terms
ORTHOPAEDIC SPINE PAIN QUESTIONNAIRE
ORTHOPAEDIC SPINE PAIN QUESTIONNAIRE NAME: DATE: ADDRESS: AGE: TELEPHONE#: RELIGION: OCCUPATION: REFERRED BY WHOM: NEAREST FRIEND/RELATIVE: TELEPHONE#: ADDRESS: PLEASE EXPLAIN WHY YOU HAVE COME TO SEE