Pediatric Potentials Occupational Therapy Forms

Using microwave to prepare food


Please complete and bring the following three forms to your first appointment:

New Patient Information Sheet

Child History and Parent Goals for Child

Release of Medical Records

Referral Form

and, if appropriate:

Sensory Processing Disorder Checklist


                                                                                                                Cooking is fun and can help with a myriad of skills
                                                                                                                including reducing tactile defensiveness, motor
                                                                                                                sequencing skills and visual motor integration.