Social Skills Intake Form

Social Skills Intake Form

  • Gender
  • The Social Skills group is Tuesday evenings starting at 5:45 pm. When would you like your child to attend? (Please select all that apply.)
  • Background Information

  • Please check all services that your child is currently receiving in the school or community setting.
  • What social skills are most important to you that you would like to see addressed with your child?
  • What forms of communication does your child typically use? (Please select all that apply.)
  • School Information

  • Type of Classroom
  • Behavior Information

  • Approximately how long is your child able to sit and attend a group activity?
  • Does your child have a behavior plan that is being used at school?
  • What are some motivators for your child?
  • What type of disruptive behaviors might your child engage in?
  • What strategies are successful in re-directing your child?