History Intake

UNDERSTANDING THE STORY IS WHERE HEALING BEGINS

Every journey starts with a story. Our history intake is the most crucial element to consider across all services that we offer, aiming to better understand your unique path. It cross-examines the following areas:

Reason for Consultation

  • Presenting concerns (i.e., behavioral, emotional, developmental, academic)

  • Individual’s/ Parent’s main goals or expectations from the consultation

Family Background

  • Parent/caregiver details (names, ages, occupation, relationship to child)

  • Siblings and family dynamics

  • Marital status or recent changes (divorce, death, relocation)

Developmental History

  • Pregnancy and birth (complications, prematurity, delivery type)

  • Early milestones (walking, talking, toilet training)

  • Sensory sensitivities (noise, touch, light, food textures)

Medical History

  • Past or current diagnoses (neurological, genetic, physical)

  • Medications (current/past)

  • Allergies

  • Hospitalisations or surgeries

Neurodevelopmental/ Behavioral Concerns

  • Diagnosed or suspected conditions (i.e., ADHD, ASD, learning disabilities)

  • Emotional regulation, Social interaction, Attention, Impulse control

  • Sleep patterns, eating habits

Attachment & Trauma History

  • Any known trauma (neglect, abuse, separation, medical trauma)

  • History of adoption or foster care

  • Bonding and attachment patterns

Educational & Social History

  • Current school placement and grade

  • Learning style and academic performance

  • Relationships with peers and teachers

  • IEPs, assessments, or educational supports (if any)

Home Environment

  • Parenting style and routines

  • Discipline strategies and effectiveness

  • Support systems (extended family, therapists, etc.)

Strengths & Interests

  • Child’s talents, passions, or hobbies

  • What motivates the child or helps them self-regulate

Parental Concerns and Questions

  • What do parents feel is working/not working?

  • Any cultural, spiritual, or family beliefs that influence caregiving

📌 Add-Ons

Standardized tools (like the CBCL, SDQ, or sensory profiles)

Consent forms for assessment or data collection

A timeline or narrative section for individuals/ parents to describe the problematic/ challenge/ child in their own words

Contact us to schedule your History Intake now.