Weekly Home Feedback
**Only fill this out if you are already receiving services at The Floortime Center and have been directed to by one of the staff**
Email address *
Today's Date *
MM
/
DD
/
YYYY
Child's Name *
Your answer
Name of Person Filling out Form *
Your answer
General Greenspan Floortime Info
How much screen time 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
What activities is he currently playing/engaging in with you (parent1)?
Your answer
What activities is he currently playing/engaging in with parent2?
Your answer
During which activities do you see the best interactions/engagement with you and/or parent2?
Your answer
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?)
Your answer
Have there been any significant changes in regulation recently? (more meltdowns, agression, sensory seeking, sleep partterns, health, etc.)
Your answer
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