Candlelight Foundation

General Information

Basic details about your child and their baseline status before joining our program

Child's Full Name *

Date of Birth *

Parent/Guardian Name *

Contact Information *

Can you describe your child's behavior, abilities, and challenges before joining our foundation?

Track improvements in how your child communicates and interacts with others

Has your child's verbal communication improved over the past three months? Please describe specific examples.

Is your child using more non-verbal communication (gestures, sign language)? If yes, provide examples.

How well is your child following and understanding verbal instructions?

How does your child interact with peers and adults? Any changes noticed?

Is your child engaging in more cooperative play with peers? Please describe.

Does your child show more interest in making friends or socializing?

Does your child initiate play with peers? Please describe.

Monitor changes in behavior, daily living skills, and learning engagement

Have there been any changes in challenging behaviors (tantrums, aggression)? If yes, please describe.

What situations or stimuli seem to trigger these behaviors?

Which behavior management strategies have been effective? (verbal praise, stickers, redirection, quiet time)

For ages 4-25: Have you noticed improvements in daily living skills (dressing, feeding, toileting)?

How well does your child follow routines and transitions between activities?

Does your child notice and respond to what's happening around them? If yes, please describe.

Have you noticed progress in learning or thinking skills? Please provide examples.

Is your child more engaged during learning activities?

Any changes in sensory preferences or sensitivities (sound, smell, touch, taste)? Please provide examples.

Update us on your child's physical health and any medical interventions

How is your child's overall health?

If taking prescribed supplements, have you noticed any improvements? (Skip if not applicable) (Optional)

Any new health concerns?

If receiving physiotherapy, have you noticed improvements? (Skip if not applicable) (Optional)

If following a prescribed diet plan, have you noticed improvement? (Skip if not applicable) (Optional)

Final thoughts on therapy progress and future support needs

Are there any new challenges or concerns that have arisen in the past three months?

How do you feel about the therapy received? (Satisfactory, Excellent, Exceptional - please explain)

What additional support or resources does your child need to continue progressing?