4.
Please describe the Client's behaviors and issues.
5.
Please describe the areas that you would like to address with the REI Custom Program.
6.
Please list any medication the Client is taking.
7.
Please list any therapies the Client is undergoing.
1 out of 8
56.
Traumatic birth experience.
57.
Frequent ear infections.
65.
History of seizure activity that is currently inactive or controlled by medication.
66.
Difficulty telling which direction a sound came from.
6 out of 8
70.
Recoils from touch; tactically defensive.
71.
Often tired, sluggish, slow moving.
73.
History of head injury.
74.
History of brain damage.
75.
Fearful of specific things (snakes, spiders, heights, people).
76.
Experiences frequent changes in sleep patterns.
77.
Bothered by/sensitive to lights.
78.
Doesn't seem to know where body is; bumps into things and people.
79.
Aggressive to others.
7 out of 8
80.
Avoids going to noisy places such as restaurants, theaters, malls.
81.
Often oblivious to certain sounds.
82.
Difficulty judging how much to extend and flex muscles when dressing or during other activities.
83.
Trouble judging the weight of an object; can’t tell the difference between two objects' weights.
84.
Prefers tight-fitting clothes.
85.
Seeks out highly physical activities involving bumping, jumping, or crashing into things.
86.
Responds negatively to light or unexpected touch.
87.
Doesn’t like washing face, brushing hair, or brushing teeth.
88.
Unresponsive or under responsive when touched.
89.
Easily startled when unexpectedly moved or touched by someone.
90.
Enjoys spinning, swinging or bouncing and has difficulty stopping these activities.
91.
Highly sensitive to minor bumps, bruises, cuts.
8 out of 8