Parent Goal-Setting Form printable pdf download

Parent Goal-Setting Form

The Center for

Therapeutic Learning and Communication, PLLC

Parent Goal-Setting Form

Child:_____________________________________

Date:________________

Therapist Name: ______________________________________________________

Please indicate below 5 or 6 goals you would like to see your child achieve in the next ____________

Rank

_______________________. Think about what you would like your child to be able to do/ or have

Order

accomplished at the end of that time period. Below are various areas of function that OT services may

Of Priority

impact upon.

(rate 1-

Ratings for Rank Order of Priority: 1= Most Important to You 5 =Least Important to You

Body and Sensory Functions:

This area includes changes in sensory functioning such as decreasing tactile

defensiveness, improving force control; and body functions such as sitting posture, coordination or balance.

Activities:

This area includes those tasks or activities engaged in or performed by the child and includes specific

skills like writing, dressing, or throwing or catching a ball.

Participation:

This area includes the child’s ability to engage in or be involved in life situations such as going to

birthday parties, going out to restaurants, participating in team sports or playdates.

Environment

This area includes aspects of the context or environment which the parents must adapt or control

in order for the child to function such as needing to structure playdates, having to vacuum only when the child is

out of the house, cutting nails when the child is asleep, or needing to bring food to a restaurant.

Parent Goal-Setting Form