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First Name *

Last Name

Email *

Phone *

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There are no wrong answers here, and this isn't a diagnosis. It's a direction. Answer the way it really is, even the parts that are hard to say out loud.

1. If you could help your child with just ONE thing right now, what would it be? *

Meltdowns, big emotions, or trouble calming down

Trouble focusing, impulsivity, or can't sit still

Clumsiness, poor coordination, or trouble with sports

Struggles with reading or handwriting

If more than one of these sounds like your child, choose the one that worries you mostright now. You can always come back for the others. Every program starts the same way.

2. What finally made you start looking for answers? *

I've felt for a long time that something doesn't add up, and nothing I've tried has explained it

Something happened recently that I can't stop thinking about

Someone else (a teacher or family member) brought it up

I'm worn out from trying things that don't stick

I just want to finally understand what's going on

Whatever brought you here, you're not overreacting, and you're not alone in this.

4. When your child melts down, how does it usually start? *

Out of nowhere, with almost no warning

There are signs, but by the time I notice them it's too late

There's usually a clear buildup

5. Once they're in it, how long does it take them to come back to themselves? *

A few minutes

Ten minutes or more

It can take over the rest of the day

6. Even after you've talked it through, does it keep happening with the same few triggers? *

Yes, the same triggers every time, and they seem as upset about it as I am

Somewhat

No, it varies a lot

4. Which sounds most like your child when it comes to focus? *

They want to focus, they just can't make their body cooperate

They can focus on things they love, but everything else is a battle

It depends a lot on the day

5. Has anyone outside your home noticed? *

Yes, a teacher or someone else has brought it up

Not yet, I've mostly been handling it on my own

I'm not sure

6. Have charts, timers, or reward systems helped? *

They worked for a week or two, then stopped

I haven't tried those

They still work fine

4. Has your child started pulling away from sports, gym class, or playground games? *

Yes, they've noticed they're behind other kids

A little

Not yet

5. As they get older, is it getting easier or more noticeable? *

More noticeable

About the same

It's improving on its own

6. Are you still helping with things like shoes, scissors, or a bike longer than you expected to? *

Yes

With some of those

No, they've caught up

4. Does your child avoid reading or writing even though you know they're capable? *

Yes, and it doesn't match how bright they are

Sometimes

No, they push through it

5. When did this start? *

From the very beginning of learning to read and write

Recently

It comes and goes

6. Have tutoring or extra practice helped? *

The same struggle keeps coming back

It helped a little

We haven't tried support yet

7. If nothing changes over the next year, where do you worry it shows up most? Select all that apply. *

Grades or how they do in school

Friendships or how other kids see them

How they feel about themselves

The stress it's putting on our whole family

I try not to think about that

8. What have you already tried? *

9. Which of these also sounds like your child? Select all that apply. *

10. Would it help to see what might be behind this, and the specific movements that support it? *

Yes, I'd like to understand it

Yes, show me where to start