Hialeah Academy of Music
Inicial Assessment
Client Full Name:
First Name
Last Name
DOB:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Check Areas of Need
Social Skills
Peer Engagement
Adult engagement
Appropriate boundaries
Reciprocal conversation
Turn taking
Impulse control
Other
Emotional Skills
Emotion Identification
Emotional expresion
Self Regulation
Transitions
Other
Motor Skills
Fine motor skills
Gross motor skills
Balance
Bilateral coordination
Other
Communication
Receptive
Sound production
Word production
Sentence production
Choice-making
Other
Cognition
Attention
Memory
Academics
Other
Acommodations
Visual
Hearing
Other
Strengths:
Musical Responses
Singing
Percussion instruments
Melodic instruments:
Visuals
Art Responses
Painting
Finger Painting
Drawing
Sculpting
Other Comments:
Type:
Frequency:
Duration
Date
Signature
*
Submit
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