Gross Motor - Goals
Gross motor – Is your child able/unable to (please describe how much assistance your child needs for each activity or transition and the age of milestone reached):
Fine Motor - Goals
Fine motor – Is your child able/unable to:
My child's present means of communication:
Please describe the augmentative communication/assistive technology that has been previously tried, the length of time of each trial, and the outcome (how did it work, or why do you think it didn't work?).
What feeding problems is your child experiencing?
Please note, we are unable to accept HMO or Medical/Medicare Plans.
Secondary Insurance Information
If you do not have secondary insurance, please skip this section.