Worksheet

Post Transforming Autism Jumpstart Program Assessment

We'd love to see what kind of shifts you saw with your child, as well as hear your feedback about the Program. Thank you!

1. ➜

Please complete these questions to the best of your ability.

It's not always easy for us parents to see the incremental changes in our child, because we see them every day. Many times it's therapists, teachers and family who will tell you the changes they see in your child! That's OK. If you're not sure, ask someone who sees your child less frequently than you do, if they noticed anything different in the last month.

2. ➜

Today's Date*

3. ➜

Parent(s) name*

4. ➜

Email address*

5. ➜

Child's name (or children) on the protocol)*

6. ➜

Child's (children's) age(s)

7. ➜

Throughout the Transforming Autism Jumpstart Protocol of 30 days, where did you find the most difficulty implementing the protocol?*

I didn't find it difficult.

Getting supplements into my child

Tracking how much of a supplement I gave each time

Following the method of giving supplements - low and slow, titrate up. This was confusing.

Not sure when to add a new supplement

Not sure of the order in which to add a new supplement

Not sure if I was doing it correctly

Getting support from my partner or co-parent to help when needed

8. ➜

Comments about specifically difficulty implementing the protocol, suggestions for improvements

9. ➜

Did you see changes in your child?*

Yes, pooping improved

Yes, we saw other improvements (comment below).

No, we didn't see any improvements.

We didn't see any obvious improvements, but believe the protocol was helpful and wish to keep going.

10. ➜

Comments about changes you saw with your child

Sometimes it's challenging to see an improvement or change that we can describe with words. Often people will tell me their child just seems more aware, or more 'with it', more 'present'. Please note if you saw shifts such as this.

11. ➜

Comments about challenges or difficulties, specifically with your child going through the protocol

Some parents have found that starting this protocol 'stirs things up', moves around toxins, or just have a hard time with the 'reactions' and knowing how to manage this. and that behaviors can get worse before they get better. Please comment if you found challenges too difficult to manage that you want to give up.

12. ➜

Because you have only implemented Month 1 of a 10-month protocol, I expect you would see some changes, but not all that is possible. Please comment on changes in any of the areas below.

Change in allergies, rashes
Change in diet, food preferences
Changes in frequency, type, smell or other characteristics of elimination
Changes in sleep
Changes in urination
Changes in stimming
Changes in hyperactivity, anxiety, focus, attention
Changes in speech
Changes in gross or fine motor skills
Changes in mood - meltdowns, tantrums, anger, crying
Changes in hearing
Changes is overall health - frequency of getting sick or time to recover from sickness

13. ➜

Do you have any suggestions for improvements for the protocol, program, support or any other aspect of what you have experienced?

14. ➜

What are your immediate goals for your child going foward from here?

15. ➜

How are your child and your family better off now than before you started this program?*

16. ➜

Thank you for your valuable feedback! Book your 30 min wrap up and next steps coaching call.

You've reached the end of this form. Thank you for being thorough!

If there are more things you remember, you can always come back and add more to the assessment.

If you cannot find a time for your call, please reach out to office@autismtransformed.com to have us help you schedule.

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