Intake Form

Playing with Purpose uses three teaching levels in our programs. This intake form will help us to determine which level is the best one for your child. All data is private and confidential. Results from this intake form will be personally evaluated by Lynn DeSalvo, a certified speech and language pathologist, and you will receive an email from her discussing your child’s placement.

Does your child understand SINGLE WORDS?
(Receptive)(required)

Does your child understand PHRASES?
(Receptive)(required)

Does your child understand SENTENCES?
(Receptive)(required)

Are they able to identify or point to objects when named?
(Receptive)(required)

Does your child use SINGLE WORDS?
(Expressive)(required)

Does your child use PHRASES?
(Expressive)(required)

Does your child use SENTENCES?
(Expressive)(required)

Can your child verbally label objects on their own?
(Expressive)(required)

Does your child have difficulty saying or pronouncing new words?
(Expressive)(required)

Does your child use VOCALIZAITONS?
(Expressive)(required)

Does your child use GESTURES?
(Expressive)(required)

Does your child POINT?
(Receptive, Expressive, and Pragmatic)(required)

Does your child vocalize, gesture, or point toward desidered objects and/or people?
(Expressive and Pragmatic)(required)

Does your child look at faces, lips, and mouths when people are talking?
(Receptive and Pragmatic)(required)

Does your child look at books?
(Receptive)(required)

When they look at books, are they:
(Receptive and Pragmatic)(required)

Does your child play with toys?
(Play)(required)

When they play with toys, do they play in their own way?
(Play)(required)

When they play with toys, do they play in a similar way to other children their age?
(Play / Stage of Development)(required)

When they play with toys, do they put the toy in their mouth or egage in sensory exploration?
(Play / Stage of Development)(required)

When they play with toys, do they play with or beside other children?
(Play / Stage of Development)(required)

When they play with toys, do they talk?
(Expressive and Play)(required)