OT Teacher Checklist

"*" indicates required fields

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Child's Name:*
Teacher's Name:*
Learning & Behaviour:*
Posture & Movement:*
Vision/Visual Perception:*
Sensory:*
If you selected "Other" please specify here.
Hand:*
Life Skills:*
If you selected "Other" please specify here.
Academic Difficulties:*
If you selected "Other" please specify here.
Level of Concern:*
This field is for validation purposes and should be left unchanged.