This questionnaire is designed to help me get more information about you, your child, and your family so that I can be most helpful to you. Please answer the questions to the best of your ability, but don’t worry if you can’t answer them all or if you don’t know certain information. Required fields are marked with an *.

Name *
Was your child adopted?
Some children can be best described as "Orchid" children. They are sensitive (emotionally, physically and psychologically). They generally pick up on things others do not. They notice textures of food, itchy clothing, and fragrances more than most. Does this describe your child?
Please mark any behaviors that your child has exhibited in the past SIX months:
Please mark any of the below traits that seem to be particular areas of strength to your child:

Thank you so much for taking the time to help me get to know you and your child better as we begin our therapeutic journey together...