Therapy Pro Telehealth Services

Participant name*

First Last

Your name, if not the participant

First Last

Best contact phone number*

Best contact email address*

Presenting difficulties:

Please tick the box if yes

Select All
Does the participant have adequate understanding and use of words/language to engage in conversations?
Is the participant an independent communicator (does not rely on support worker/parent)?
Does the participant have basic literacy skills?
Does the participant have access to Zoom via a tablet/laptop/desktop?

Does the participant have difficulty with any of the following social skills:

Please tick the box if yes

Please place any additional explanatory comments here that will help our facilitators place the participant in the most suitable group session.

Group Sessions Questionnaire