Create-abilities High School Questionnaire

HIGH SCHOOL QUESTIONNAIRE

Create-abilities
Your student has an Occupational Therapy Handwriting Assessment with Nadia Brown at Create-abilities. Your opinion of this student's handwriting abilities and difficulties is very important. We would ask you to complete this questionnaire to enable us to gain a true picture of this student's handwriting within the school environment where extended periods of handwriting are required and often under time constraints.
Please fill in the form below or if you prefer to print a questionnaire and post it to Create-abilities, CLICK HERE

Student name year age male female

School Principal Phone

in your opinion, does this student have difficulties in any of the following in comparison to classmates?

GENERAL HANDWRITING SPEED eg slow copying notes from board yes no
comments

HANDWRITING ENDURANCE & SPEED OVER TIME eg completes general handwriting tasks within an adequate time frame, however is noticeably slower when required to copy or write for extended periods of time yes no
comments

FATIGUE & CRAMPING DISCOMFORT eg student is seen to pause, put pen down & shake out hands, or stretch/press fingers & hands etc yes no
comments

HANDWRITING LEGIBILITY yes no
comments

KNOWLEDGE BASE DOES NOT MATCH HANDWRITING OUTPUT yes no
comments

are there any strategies that have been employed to assist this student with handwriting at school?
comments

other comments

name of person completing questionnaire
position date

please contact Nadia at Create-abilities if you wish to further discuss this student's handwriting
0420 942 129 or email nadia@create-abilities.com.au
Nadia Brown, Paediatric Occupational Therapist, B.App.Sc.(OT), MHS(OT), AccOT.

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