Quiz – Optimal Learning Skills

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QUIZ

Welcome, and thank you for your interest in our quiz.

Are you taking this quiz for yourself, your child/teen, or your student?*

Myself Child/teen Student

Name - Student*

What is your:

Age?*

Does your child have difficulty sitting still?

Yes No Not sure

Do you:

Does your child have difficulty staying on task for any length of time?

Yes No Not sure

How would you describe your:

Does your child have trouble being easily distracted?

Yes No Not sure

Were you:

Does your child have avoidance of work that seems complicated or hard?

Yes No Not sure

Did you:

Does your child have difficulty comprehending and remembering?

Yes No Not sure

Did you:

Does your child have problems sounding out words?

Yes No Not sure

Did you:

Does your child have written work that takes a long time to complete?

Yes No Not sure

Did you:

Does your child have difficulty completing tasks?

Yes No Not sure

Did you:

Does your child have difficulty copying material from a book or whiteboard that takes a long time?

Yes No Not sure

Did you:

Does your child have difficulty with verbal instructions that often need to be repeated?

Yes No Not sure

Did you:

Does your child have difficulty with reading and spelling?

Yes No Not sure

Did you:

Does your child have problems making reversals, for example, confusing the words "was" and "saw" or the letters "b" and "d"?

Yes No Not sure

Did you:

Does your child have frequent disorganization?

Yes No Not sure

Did you:

Does your child have frequent frustration when trying to complete a task or assignment?

Yes No Not sure

Did you:

Does your child have frequent or "careless" errors?

Yes No Not sure

Your Contact Information

First Name

Last Name

Email

Phone

How did you hear about Optimal Learning Skills?*

Online Search Professional Referral Parent Referral Event Social Media Teacher Sign Other

Would you like to speak to our team about further assessment or intervention?*

Yes, please contact me No, thank you

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