Adult Assessment


I. Personal Information

II. Guardian Information if applicable

III. Medical History:

Please give date of last medical exam(s):

IV. Adult/Guardian Observations:







V. Present Physical Condition:
























VI. Sensory Patterns:

If you have checked yes to the boxes above, conductive education may not be recommended.

VII. General Questions:


This application has been completed by:


Please, fill out online or mail your completed Assessment Application Form and any additional medical or educational reports if available.

Once you complete this form, please call our office to schedule a free, in person assessment.

Conductive Education Center of Orlando
931 South Semoran Blvd
Suite 220
Winter Park, FL 32792

Phone: 407-671-4687
Fax: 407-647-3833

If you will not be able to travel to Florida, submitting a video following the Video Assessment Guidelines will suffice. We look forward to meeting you!

Please prepare a home video that captures your child’s capabilities in functional activities, such as: 

  • Lying
  • Rolling
  • Sitting
  • Standing
  • Crawling
  • Walking
  • Self-care (including eating, dressing, etc.)
  • Conversing (to you, someone else or to the camera) if applicable

**Please show your child with any special equipment that he/she utilizes while doing the above tasks.


The intent is to show our conductors what your child is capable of doing and for our conductors to assess the assistance level needed and view their own level of motivation to participate in each activity. We also love to see what your child CAN do, their uniqueness, and get to know their wonderful personality.

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