1. Basic Information:
What language(s) does your family currently use most often at home?
Number of Family Members
Child's Name
Age
Type of disability, diagnosis, or area of concern
3. Home Language Background:
What language(s) were primarily spoken at home?
Any specific communication needs or preferences?
4. Previous Support Services:
Did your child receive any developmental, educational, or health services before? If yes, please describe briefly.
5. Goals and Expectations:
What goals do you have for your child's development?
Any specific expectations from our program
6. Health and Medical Information:
Relevant health or medical information about your child (if applicable)
Current Medications or Treatments
7. School/Program Information:
Current school or program (if applicable)
Any ongoing support at school
8. Cultural Considerations:
Are there cultural values, traditions, or practices that are important for your family to maintain while living in Canada?
9. Pre-immigration Information:
Was your child born in Canada? If not, in which country and city were they born?
Were the parents born in Canada? If not, please specify the country of birth and the year they arrived in Canada.
10. Additional Comments:
Is there anything else you would like us to know?
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