Household Tool Checklist for Teletherapy
Please fill out this form so that our therapists know what tools and materials are available in the home to be used during teletherapy sessions.
Preferred mode of contact:
Please select your primary therapist:
Julie Neumann, MA, OTR/L
Sandy Manns, COTA/L
Alyssa Erlandson, MOT, OTR/L
Heather Winters, MA, OTR/L
Betsy Haag, MS, OTR/L
Samantha Kraus, MS, CCC-SLP
Michelle Koyama, MA, OTR/L
Kristie Gonzalez, MA, CCC-SLP
Steph Peterson, MA, OTR/L
LeAnn Taylor, MA, CCC-SLP
Becca Goldenstein, MA, OTR/L
Computer or other technology equipment to video conference:
Do you have reliable Internet?
Do you have a working printer?
Meeting space(s) available in your home:
Will the parent/caregiver be available during therapy sessions?
Yes, a parent/caregiver will be present during therapy sessions
Yes, a parent/caregiver will be available as needed
No, a parent/caregiver will not be available
Are you available to gather materials before the session?
Does the client know how to move the camera on the device so that the therapist can see their upper and lower body during the therapy session?
Please indicate which of the following household items you have access to:
Chip clips or clothespins
Please indicate which of the following school supplies you have access to:
Please indicate which of the following craft supplies you have access to:
String or yarn
Games and Toys
Please indicate which of the following games and toys you have access to:
Medicine ball (large exercise ball)
Bosu ball (dome shaped balance platform)
Should be Empty: