Forms | HandwritingSolutions

Thank You for Signing Up!

Prior to the first assessment, we need to collect an Intake Form, Payment Form, & Waiver of liability which can be submitted below. Thank you!

Intake Form

Child's Name

Today's Date

Child's Date of Birth

Any allergies:

Parent Name(s)

Contact Email

Phone

Emergency Contact

Address

Current Grade

School

Would you like me to contact your child's teacher?

Yes

If YES, teacher’s preferred contact information (email or phone):

I hereby authorize “Handwriting Solutions” to contact my child’s teachers to discuss handwriting tutoring, assessment findings, and plans for remediation.

Parent Signature

Today's Date

Current handwriting curriculum

Diagnosis (If any):

Hand preference:

Left

Right

Undecided

Parent/Teacher Concerns:

IEP/504plan (any accommodations in school):

Does your child receive any other tutoring/therapy/services?

Yes

If so, please explain:

What do you hope to gain from handwriting tutoring?

How would you describe your child (personality, hobbies, interests)?

Attach Handwriting Sample (Optional)

Upload File

Thank You for Signing Up!

Intake Form

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