Observations Tomatis form for Teachers, Parents, Caregivers

To ensure we provide you with the most effective and tailored experience, we kindly request that you complete this intake form. Your input will help us better understand your unique needs and goals, enabling us to craft a personalized program that best suits you.

Thank you for taking this crucial first step towards transformative change.

Observation Form
Name
Name
First
Last
Initially, you may notice an increase in sensitivity and emotionality. This is in response to the impact of change in the nervous system, essentially causing the brain to shift and re-organize. This may feel unsettling for the child / adult, though would be temporary. Any of the activities below could be affected by the therapy and changes could occur quickly or over time. Take care to note any little detail in the areas noted below and make sure you give return this sheet.   This information will allow the lead consultant to follow the progress and shifts at home. Your feedback is very important to us and assists us in programming effectively for you and / or your child.
Write in to the box 1 - 5, 1 being the lowest and 5 being the highest change.
Falling asleep
Okay
Staying asleep
Okay
Waking up too early
Okay
Getting up too late
Okay
Groggy in morning
Okay
Eating well
Okay
Any new foods early
Okay
Good bowel movement
Okay
Bladder control
Okay
Playing on playground
Okay
Sports
Okay
Handwriting
Okay
Scissor skills / use of utensils
Okay
Verbal expression in conversation
Okay
Expression of emotions verbally
Okay
New sounds
Okay
Listening to instructions
Okay
Frustration tolerance
Okay
Emotional Meltdowns
Okay
Play with siblings
Okay
Play with peers
Okay
Imaginary play
Okay
Tooth Brushing
Okay
Getting dressed in AM
Okay
Needing verbal reminders to get ready
Okay
Needing reminders to shower/bath
Okay
Doing homework independently
Okay
Reading
Okay
Math
Okay
Written Expression
Okay
Attention in non-preferred activity
Okay
Fidgetiness
Okay
Fidgetiness
Okay
Forbrain
Okay

Thank you!!!!!


GENERAL EMOTIONS.

COMMUNICATIONS generally improved?

GENERAL OBSERVATIONS TO CONSIDER

THE COCHLEAR SYSTEM

VESTIBULAR/COCHLEAR

GLOBAL CHANGES TO BE AWARE OF.

Jennifer Muller

Tomatis® Level 4 Consultant