Your Name
              
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                    First Name 
                   
                
                
                  
                    Last Name 
                   
                
               
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              Childs Name
              
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                    First Name 
                   
                
                
                  
                    Last Name 
                   
                
               
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              Grade
              
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                    Pre-K 
                  
                    K 
                  
                    1st 
                  
                    2nd 
                  
                    3rd 
                  
                    4th 
                  
                    5th 
                  
                    6th 
                  
                    7th 
                  
                    8th 
                  
                    Other 
                  
                     
              
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
              
                
            
              Email
              
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              Phone
              
             
          
                
                
                
                  
                    (###) 
                   
                
                
                  
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              Select your location:
              
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                    Gig Harbor 
                  
                    Bainbridge 
                  
                    Olympia 
                  
                   
              
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              Select your therapist
              
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                    Jason Weigold, COTA/L 
                  
                    Julie Kennedy, COTA/L 
                  
                    Amanda Diaz, COTA/L 
                  
                    Thomas Harris, COTA/L 
                  
                    Brittany Fox, COTA/L 
                  
                    Arielle Langworthy, OTR/L 
                  
                    Savannah Wyatt, COTA/L 
                  
                    Sally Carman, OTR/L 
                  
                    Mike Peachman, OTR/L 
                  
                    Mel Peachman, OTR/L 
                  
                    Ashley Shadle, OTR/L 
                  
                    Elysia Smith, COTA/L 
                  
                    Adan Pizana, COTA/L 
                  
                    Aitikah Rossett, COTA/L 
                  
                    Erin Renard, COTA/L 
                  
                    Crystal Allarde, COTA/L 
                  
                    Emily Bryce, OTR/L 
                  
                    Makaylah Mitchell, COTA/L 
                  
                    Season Feldt, OTR/L 
                  
                    Mackenzie Vannatta COTA/L  
                  
                    Alyssa Beck OTR/L 
                  
                    Alyssa Cheesman COTA/L  
                  
                    Jessica Dawson, COTA/L 
                  
                    Jenny Bitner, ORT/L 
                  
                    Camryn Gunderson, OTR/L 
                  
                    Ashley Mbabazi, OTR/L 
                  
                   
              
            
            
            
            
            
            
            
        
          
          
            
            
            
            
              
                
            
              1. In what areas has your child shown growth and improvement?
              
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                Please share any progress you've noticed, whether in emotional regulation, body awareness, social interactions, or other key areas.
                
               
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
              
                
            
              2. Which therapy strategies or recommendations have you successfully implemented at home?
              
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                We’d love to hear about the techniques, activities, or approaches that have been most effective in supporting your child’s progress outside of therapy.
                
               
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
              
                
            
              3. Are there any ongoing challenges or new concerns you'd like to address? What areas of concern would you like to focus on next?
              
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                Your input helps shape therapy sessions to best support your child’s needs. Let us know any current struggles and the skills you’d like to see further developed.
                
               
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
              
                
            
              4. How can therapy better support you in your role as a parent?
              
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                Whether it’s clearer milestones, additional resources, or more guidance on specific strategies, we want to ensure therapy is a valuable tool for both you and your child.
                
               
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
              
                
            
              5. What other activities, therapies, or programs is your child participating in?
              
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                Please list any sports, creative classes, or other programs your child is involved in. Understanding their full range of activities helps us support their overall development.
                
               
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
        
         
      
      
      Thank You for Your Feedback! 
We appreciate you taking the time to share your insights and updates. Your input helps us tailor therapy to best support your child's progress and ensure we’re working toward meaningful goals together.
If you have any additional thoughts or questions, feel free to reach out. We're here to support you every step of the way!
– Jason A. Weigold and the CTI Team