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Parent Questionnaire for Consulting, Assessment, and Tutoring Services
Thank you for taking the time to fill out this pertinent information concerning your child. Your answers will only be used to help me get to know your child as a reader. Please complete this form prior to our assessment or consultation meeting.
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1. List the strength(s) your child has as a reader (e.g. can read many words by sight, has great listening comprehension)
Your answer
2. List the weakness(es) your child has as a reader. (e.g. struggles with comprehension, difficulty decoding or reading fluently)
Your answer
3. Do you know of any difficulty with learning to read in your family history or with speech/language?
Your answer
4. How do you feel your child does with writing and spelling?
Your answer
5. If attending school, where does your child attend and is your child receiving any additional reading instruction in school? If homeschooled, what are you currently using for reading curriculum?
Your answer
6. Has your child participated in any standardized assessments or evaluations at school or home? If so, which ones?
Your answer
7. Is there any other information you’d like me to know about your child?
Your answer
Your Name
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Your child's name
Your answer
Your child's age and grade
Your answer
Phone number
Your answer
Preferred communication
email
phone
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