Occupational and Physical Therapy Questionnaire

1 Taste and Smell
2 Muscle Tone
3 Coordination and Development
4 Auditory
5 Tactile
6 Vestibular
7 Visual
8 Behavior or Temperament
9 School-Aged Children Only
  • Some of these questions may not reflect the age of the person you are describing. Please skip these if they do not pertain to your child. You may add narrative at the bottom of this form for a more specific description of your child.
  • Taste and Smell