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
Child's Name
Childs Age
Your Name
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