Handwriting Readiness Class Questionnaire
Welcome to our Handwriting Readiness Class! You are receiving this questionnaire because you indicated that your area of concern is handwriting. Please complete the following to give us more information about your child’s abilities, as well as to let us know your primary concerns.
Parents Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Child's Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Questionnaire completed by:
*
School and Grade:
*
Do you have health insurance
*
Please Select
Yes
No
If yes, please let us know your provider
Handwriting Readiness Questionnaire
Is your child motivated to write or draw?
*
Please Select
Yes
No
Comments
Does your child draw circles, lines or scribble on paper?
*
Please Select
Yes
No
Comments
Does your child understand directionality(e.g., up and down, left to right)?
*
Please Select
Yes
No
Comments
Does your child sit for at least 10 minutes in a seat for tabletop activities?
*
Please Select
Yes
No
Comments
Does your child grip a writing tool with an appropriate amount of force?
*
Please Select
Yes
No
Comments
Does your child have a strong hold or loose hold on the writing tool?
*
Please Select
Yes
No
Comments
Does your child use an adaptive device such as a “pencil grip”?
*
Please Select
Yes
No
Comments
Does your child write their name?
*
Please Select
Yes
No
Comments
Can you read your child’s written work?
*
Please Select
Yes
No
Comments
Does your child write a sentence independently at home?
*
Please Select
Yes
No
Comments
Is your child able to follow directions independently?
*
Please Select
Yes
No
Comments
Does your child receive extra support for writing in school?
*
Please Select
Yes
No
Comments
Please provide any further information that will help us understand your child and your concerns.
Please verify that you are human
*
Thank you! We look forward to working with you and your child.
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