Prior to your (child’s) evaluation, please download and fill in the client questionnaires and forms below.
These assessments help us understand the functional difficulties that you/your child may be experiencing on a daily basis, and the unique, underlying contributing factors. The time invested in filling out these forms are important to you/your child’s success in therapy.
(We may request that you fill in other questionnaires if we feel they will help us understand your child better.)
Please return your completed questionnaires to us by:
Fax: (973) 828-8034
Mail: The Thrive Group
c/o Miriam Manela
68 Ascension Street
Passaic, NJ, 07055
It is best if we receive your completed questionnaires 48 hours before an appointment. We use these to assess the client through the eyes of his/her caregivers.
Please note: The Thrive Group is currently in a transitional phase regarding its name change. For the time being and for insurance purposes and documentation, please use our group’s previous name: “Thrive Occupational Therapy.”
CLIENT QUESTIONNAIRES AND FORMS
- WELCOME LETTER (For parents of clients 0-18 years old)
WELCOME LETTER (For clients filling it out for themselves)
- Please fill out the THRIVE QUESTIONNAIRE by circling all statements that the client has difficulty with and the issues that you would like addressed during therapy. If some issues are priorities for you, please prioritize by using numbers in the circles instead of checks. If you’d like to do this with your child (assuming he is old enough to be part of the process), please use two different color pens, one for your priorities and one for your child’s.
- FUNCTIONAL ASSESSMENT (Ages 0-15)
FUNCTIONAL ASSESSMENT (AGES 15 AND UP)
- THRIVE HIPAA FORM
- SENSORY PROFILE
Please call or email the office, and we will send you a link for the Sensory Profile form. It can be completed on an external website and is available by invite only.
- PEDIATRIC SYMPTOM CHECKLIST
Please place your initials next to each paragraph and sign and date at the end of the document.