Preschool Visual-Motor Integration Assessment Form
Use this form to evaluate a preschool child's visual-motor integration skills through structured observations and ratings.
Child's Full Name
*
First Name
Last Name
Child's Age
*
Assessor's Name
*
First Name
Last Name
Date of Assessment
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Observation Context
*
Please Select
Classroom
Playroom
Therapy Room
Home
Other
Visual Tracking
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Copying Basic Shapes
*
Not Able
1
2
3
4
Accurate
5
1 is Not Able, 5 is Accurate
Fine-Motor Control
*
Needs Support
1
2
3
4
Independent
5
1 is Needs Support, 5 is Independent
Hand-Eye Coordination
*
Poor
1
2
3
4
Excellent
5
1 is Poor, 5 is Excellent
Please rate the following drawing/marking tasks
*
Rows
Not Attempted
Attempted
Completed with Support
Completed Independently
Draws a straight line
1
2
3
4
Draws a circle
5
6
7
8
Draws a square
9
10
11
12
Draws a cross
13
14
15
16
Submit Assessment
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