MEFS qEEG BRAIN MAP

Preview Intake Form

YOUTH CEC 5-18

Estimated time: 4 minutes


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Short Attention Span & Focus.
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Lack of Motivation/Poor Follow through.
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Procrastination/Puts Things Off.
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Difficulty with Decisions.
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Daydreams or Spaces Out.
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Careless Mistakes.
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Easily Distracted.
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Disorganization/Forgets & Loses Things.
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Socially Inappropriate.
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Poor Judgement.
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Poor Short Term Memory.
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Constant Worry.
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Sensitive To Light & Noises.
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List Learning Problems.
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Angry & Aggressive.
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Emotional Outbursts.
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Restless/Impatient/Easily Frustrated.
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Hyperactive.
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Argumentative.
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Oppositional.
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Personal Space Problems.
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Verbally Impulsive/Talks Rapidly.
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Shy & Anxious.
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Acts out of control.
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Event Sequence Problems.
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Forgetful.
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Monotone Speech.
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Scary Thoughts.
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Can't recall more than one request.
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Poor Math Skills.
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Poor reading comprehension.
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Trouble shifting attention.
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Whines Excessively.
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Stuck On Thoughts.
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Stuck on Behaviors.
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Bargains Constantly.
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Insomnia.
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Fearful Rumination.
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Needs Things Done A Certain Way.
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Misperception of Others.
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Doesn't Listen Carefully.
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Dyslexia.
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Reads Poorly.
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Poor Handwriting.
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Clumsy.
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Lacks Fine Motor Skills.
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Constantly Moving.
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Difficulty with Task Sequence.
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Difficulty Learning New Words.
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