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DOWNLOAD SENSORIMOTOR HISTORY FORM

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  • Date Format: MM slash DD slash YYYY
  • BASIC SENSORY FUNCTIONING

    Please check yes or no for each item. Mark N/A for any items not appropriate for your child. If any characteristic was true at a younger age but is no lon ger, please indicate by checking the appropriate box.
  • VISUAL

  • AUDITORY

  • GUSTATORY - OLFACTORY - ELIMINATION

  • MOTOR SKILLS

  • SOCIAL - EMOTIONAL