Step 1 of getting started

Speller intake form

Thank you for reaching out! Your answers help Sunny understand your speller's strengths, history and goals before your consult call. Share as much as you're comfortable with — there are no wrong answers.

Sunny TalbertCertified Spellers Provider. I'll personally read every answer.

New speller demographics

Speller name Birth date

Which service are you interested in?

Gender

Male Female

Street address City State Zip

Primary contact

Full name Cell phone Email

Preferred method of contact

Phone Text Email

Secondary contact (optional)

Full name Cell phone Email Preferred contact

Motor skills inventory

Describe your speller's motor profileFor example: walking, pincer grasp, toilet function. Please highlight their strengths too.

Spelling history

How did you hear about Spelling with Sunny? Spelling experienceWhat method(s) has your speller received training in? Does your speller work with a local provider? If so, who? Communication partner trainingWhat level of training have you received as a communication partner, if any?

Current fluency & duration

If your speller has experience, how long have they been spelling? Are they open or fluent with any providers or communication partners? Describe their current level of open communication or fluency

Program goalsWhat are 2 goals you have for your speller's program? Please be as specific as possible.

Sensory processing inventory

Is your speller sensory-seeking or sensory-defensive?Think across sight, sound, touch, taste, smell, movement and body awareness (interoception).

Social & emotional inventory

Current supportsWhat supports does your speller have across environments, such as school or home? Social & emotional profileFrustration tolerance, impulse control, known triggers, and what helps them feel calm.

Medical history

Current medicationsHow long have they been on this regimen, and is it a good fit? Current diagnoses Prior therapiesInclude any relevant results. AllergiesList any allergies and reactions.

History of seizures?

Yes No

Date of last seizure (if applicable)

Known triggers Any other health issues

Speller video

Video linkA short clip of your speller helps Sunny prepare. Share a Google Drive, unlisted YouTube or Dropbox link.

Initial questions

What questions would you like Sunny to address first?

Consent & signature

I have read and agree to the statement above.

Signed (type full name) Date

Your information is confidential and shared only with Sunny. She'll reach out to schedule your consult call.