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C17, SK Puri, Patna 800001
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HOME
ABOUT
THERAPY
Occupational Therapy in Patna
Speech Therapy in Patna
SERVICES
ONLINE ENROLLMENT
GALLERY
BLOG
TEAM
CONTACT US
Book a Visit
Online Enrollment
Online Enrollment Form
Child Name
Parent's Name
Child's Gender
Child Age
Mobile Number
Your Email
Does the child respond when his name is called out?
Yes
No
Is the child able to make eye contact with an adult?
Yes
No
Is the child able to follow simple instructions?
Yes
No
Can a child give sustainable attention?
Yes
No
Does the child walk steadily?
Yes
No
Is the child able to speak?
Yes
No
Is the child able to pronounce words with clarity?
Yes
No
Does the child enjoy playing with kids of his/her age?
Yes
No
Is the child involved in Aloof play?
Yes
No
Is there any pre-diagnosis?
Yes
No
Is there any motor difficulty the child is facing?
Yes
No
Is the child able to answer open ended questions like (how was your day?, what all happened in school)
Yes
No
Does the child know what to do with common things like a brush, phone, spoon?
Yes
No
Does the child copy simple actions and words?
Yes
No
Do you feel he has lost skills which he had once?
Yes
No
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