Weekly Home Feedback for Therapists
**Only fill this out if you are already receiving services at The Floortime Center**
Please enter the email address of the therapist you'd like to read this. You can only enter 1 address.
Email address *
Today's Date *
MM
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DD
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YYYY
Child's Name *
Name of Person Filling out Form *
General Greenspan Floortime Info
How much screen time (including educational games/programs) is your child getting per day on average? *
How much Greenspan Floortime are you (parent1) and parent2 doing per day *
A Lot (3 or more 30 minute sessions a day
Medium (two 30 minute sessions a day)
A little (one 30 minute session a day)
None or less then one 30 minute session per day
Parent1
Parent2
Describe the most successful activities is he currently playing/engaging in with you (parent1)?
Describe the most successful activities is he currently playing/engaging in with parent2?
Are you seeing the activities/interactions/ progress and become more complex with you and/or parent2? (If yes, please describe)
Have there been any big changes in how engaged he/she is with you or parent2 in a one on one setting? (i.e. Is he currently showing a preference for more solo play?)
Have there been any significant changes in regulation recently? (more/fewer meltdowns, aggression, sensory seeking, sleep patterns, health, etc.)
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