This Questionnaire concerns:
This questionnaire is a ‘jumping off point’.
Please keep your answers as brief and focused as possible
I just need a picture to start with...
Many people find this process very helpful in itself for clarifying the issues and preparing for the sessions. However if you feel daunted or stressed by it then we can pick up these details as we go, although it may make our sessions a bit longer.
WARNING: DO NOT CLOSE THIS PAGE WITHOUT CLICKING THE 'SUBMIT FORM' BUTTON FIRST!
If the page is closed without clicking the button, all of your answers will be lost. If you have to stop part way before finishing, please click 'Submit Answers' and start a new questionnaire form later to complete. Alternatively, you may wish to compose answers on a separate document and copy-paste them into this form later.
As you record your answers please consider the following details if relevant:
Growth and development, movement, sleep, speech,
play, social interaction, home/school interaction issues, programs/extra-curricular activities, likes/dislikes/ fears/anxieties/obsessions/tendencies, health/illnesses/therapies, family structure/schedules/roles, interests/gifts/talents, and anything else you feel might be helpful?
Your answers have been sent to Mary.
Please provide a photo of the child/ren and one of the family together by either:
Using this web form
Or by attaching and sending photos via email to firstname.lastname@example.org (ensure your name is included).