• Art Therapy Assessment

  • DOB*
     - -
    2 digit month, 2 digit day, 4 digit year

  • Assessment Period

    6 months
  • Start Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • End Date*
     - -
    2 digit month, 2 digit day, 4 digit year

  • Rating Scale:

    • Never/Rarely – Does not do the action, does so infrequently, skill is not present, etc.
    • With Support – Does the action given verbal prompts, physical prompts, visual supports, etc.
    • Independently – Does the action when appropriate, does not need support, skill is present, etc.
    • Not observed – Not age appropriate, not addressed in assessment, etc.
  • Social*
    Rows
  • Emotional*
    Rows

  • Art Therapy Assessment

  • Cognition and Academics*
    Rows
  • Communication/Language*
    Rows

  • Art Therapy Assessment

  • Motor*
    Rows
  • Vision and Hearing*
    Rows

  • Art Therapy Assessment

  • Sensory Responses and Needs*
    Rows

  • Art Therapy Assessment

  • Coping Skills and Regulations Strategies
    Rows
  • Personality/Affect
    Rows

  • Art Therapy Assessment

  • Art Responses and Activities
    Rows

  • Art Preferences:

  • Art Therapy Assessment

  • Treatment Recommendations:

  • The art therapist recommends that continues services with 60 minutes sessions    times per week. The following goals and objectives are suggested to target during the first part of the treatment plan:

  • Date:*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Should be Empty: