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Occupational Therapy Review Form

This form is confidential and will only be used by the intended recipient for information purposes.



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Slindon College's Occupational Therapy Team are members of Royal College of Occupational Therapists and registered with the Health and Care Professions Council


 
First name
Surname
DOB
Is an EHCP in place?
 
Full name(s)
Mobile number
Home phone number
Who has parental responsibility?
Has your son been seen by any new professions in the last 12 months?
 Name of service providerContact detailsDate of supportAdditional information

Please provide an update regarding the below skill areas and any strengths and challenges you son has within the below areas.

Sensory



Touch (e.g do they dislike messy hands, not like certain textures, dislikes/likes people touching them etc?)



Smell (e.g doe they notice smells that others don’t, are they bothered by smells etc?)



Vision (e.g are they bothered by bright lights etc?)



Auditory (e.g do they dislike loud noises or busy environments, seek out music etc?)



Food (e.g do they have limited diet/dislike certain foods, do not like food touching, do not like eating in front of others etc?)



Movement (e.g are they often bumping into people or objects, have difficulty staying still, easily dizzy, poor balance, difficulty accessing stairs etc?)



Interoception: (e.g: can they recognise when they are hungry, thirsty, in pain, feeling hot/cold or need the toilet?)


Data Protection



When pupils are referred into the Occupational Therapy service we hold data about them to help us deliver the right support (e.g. information gathered from family members/professionals). This helps us track the effectiveness of intervention, and ensure high quality. The data is kept securely (in line with the school data policy), and would only be shared with those who need to know.


Parent/carer consent*