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School Readiness Questionaire

Please complete this quick assessment. If you choose to submit this I will be in contact to discuss your needs.

Questions

Please answer each question by clicking yes or no.

	Yes	Uncertain	No	No answer
Does not like wearing tight clothes	Yes	Uncertain	No	No answer
Bed wetting beyond age 5	Yes	Uncertain	No	No answer
Sitting still is difficult	Yes	Uncertain	No	No answer
Being alone or being alone in the dark is a challenge	Yes	Uncertain	No	No answer
Anxiousness	Yes	Uncertain	No	No answer
Startles easily with unexpected noise	Yes	Uncertain	No	No answer
Oversensitive to sound, touch or light	Yes	Uncertain	No	No answer
Motion Sickness	Yes	Uncertain	No	No answer
Hunched posture	Yes	Uncertain	No	No answer
Props head on hand while sitting	Yes	Uncertain	No	No answer
Poor balance	Yes	Uncertain	No	No answer
Walks unevenly on foot eg toe walking	Yes	Uncertain	No	No answer
Poor core strength	Yes	Uncertain	No	No answer
Uncoordinated or clumsy	Yes	Uncertain	No	No answer
Difficulties throwing or catching	Yes	Uncertain	No	No answer
Difficulties kicking a ball	Yes	Uncertain	No	No answer
Tense, holds body stiffly	Yes	Uncertain	No	No answer
Difficulty paying attention, concentrating	Yes	Uncertain	No	No answer
Difficulties kicking a ball	Yes	Uncertain	No	No answer
Tense, holds body stiffly	Yes	Uncertain	No	No answer
Difficulty paying attention, concentrating	Yes	Uncertain	No	No answer
Movements of the mouth/tongue while writing	Yes	Uncertain	No	No answer
Letter reversals beyond age 7	Yes	Uncertain	No	No answer
Poor spelling	Yes	Uncertain	No	No answer
Shyness, challenge to assert oneself	Yes	Uncertain	No	No answer
Reading challenges	Yes	Uncertain	No	No answer
Poor handwriting	Yes	Uncertain	No	No answer
Speech challenges	Yes	Uncertain	No	No answer
Over-active	Yes	Uncertain	No	No answer
Frequent emotional outbursts	Yes	Uncertain	No	No answer

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