Read and Bloom Tutoring: Initial Information

Operated by a certified ESE and reading teacher, Read and Bloom Tutoring is dedicated to providing specialized reading instruction based on The Orton Gillingham Approach. We offer personalized tutoring services to let every learner blossom into confident readers.

Please answer the questions below regarding your child. There is no right or wrong answer. Any information helps! If you have questions, please contact Jessica @ 321-312-0769

Sign in to Google to save your progress. Learn more
Child's Name and/or what they go by *
Age and Grade  *
Parent(s) or Guardian's Name *
Best Phone Number(s)
Best E-mail Address *
What is the best way to get in contact with you? *
What type of school does your child attend? *
What are your child's BEST qualities? Caring, determined, kind, works well as a team, friendly etc. Please brag about your child here :)  *
Where do you prefer to hold tutoring sessions? *
Which dates or times are best for you?
Please note: Availability is not guaranteed based on your selections. 
Would you be open to or interested in group sessions-up to 3 children? If yes, do you have other families in mind? *
What are your areas of concern with your child's academic performance and learning? What are your goals? *
Has your child's teacher (or previous teachers) addressed concerns? If yes, please explain.  *
How does your child feel about their academic ability?  *
Does your child have a 504 Plan or IEP? If yes, please give me a brief description of his/her plan.  *
Does your learner have any medical diagnoses that I should be aware of? *
Is there any additional information you would like to share with me? 
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy