PRE-ASSESSMENT FORM Child's Name * First Name Last Name Your Name * First Name Last Name Email * Phone * (###) ### #### Where are you located? * How old is your child? * Medical, School, or Developmental Diagnoses: * Tell us how they primarily communicate with you * 1 word 2 word phrases 3 or more word sentences Gestures/Body Language Sign language Communication Device Other If Other, please specify Please describe any sensory needs your child displays * e.g., uses chewy, needs specific clothing, etc. Please describe your child's swimming abilities and water safety skills to the best of your knowledge * Anything else we should know? Thank you so much for submitting the pre-assessment form. Someone from our team will reach out to you shortly regarding our availability, pricing, questions, etc. We greatly appreciate you and are excited to connect! Talk soon!
