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In the Meantime Handbook
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Pre-Assessment Quiz
Have you or your loved one experienced any of the following?
Check all that apply:
Anger outbursts
Anxiety
Blurting out in conversation
Cannot copy shapes
Cannot form letters
Cannot recall what they read
Cannot sit still
Cannot understand math word problems
Challenges completing homework
Clumsiness
Depression
Difficulty focusing
Difficulties in math
Difficulties with reading
Difficulty understanding others’ emotions
Difficulty understanding own emotions
Disorganized
Doesn’t express emotion
Excessive shyness
Fidgeting
Flapping
Highly emotional
Hyper focusing
Inattentiveness
Messy handwriting
Needs frequent repetition
Not listening when spoken to
Poor handwriting
Poor grammar
Poor memory
Poor punctuation
Poor spelling
Problems making / keeping friends
Problems staying organized
Problems using or understanding language
Restlessness
Rocking
Slow handwriting
Slow reader
Standing to work
Stomps when walking
Takes a long time to understand material
Talking obsessively about one topic or idea
Trouble following directions
Trouble putting thoughts into writing
Trouble telling time
Walks on tiptoe
First Name of individual described above:
Last Name of individual described above:
Age (in years) of individual described above:
Gender of individual described above:
Select a gender
Male
Female
Other
Your Name (if different from above):
Your Email Address:
Your Phone Number:
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Preferred Location:
Burlington
Windsor
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