Welcome to your Regulation Profile Roadmap™

The Play Haven Assessment™ helps us understand your child's regulation patterns, play needs, home environment, and the supports that may help your family create more connection and meaningful play.

This is not a diagnostic evaluation or therapy assessment. It is a parent-friendly, therapist-informed intake designed to help us build your personalized Play Haven recommendations.

Section 1 of 9

Parent + Child Information

Parent/Caregiver Name *

Email Address *

Child’s First Name *

Child’s Age *

Child’s Gender/Pronouns

Who lives in the home with the child?

Are there siblings or other children in the home?

Does this child regularly share the play space with siblings or other children?

If no, the sibling/shared-space questions will be skipped.

What is your biggest hope for this Play Haven Assessment™?

Examples: fewer meltdowns, more independent play, calmer routines, clearer play spaces, less overwhelm, better understanding of your child.

Section 2 of 9

Mini Quiz Integration

Have you already completed the free Play Haven Regulation & Play Profile Mini Quiz?

What was your child’s primary profile?

What was your child’s secondary support profile?

Did the quiz result feel accurate?

Anything you want us to know about the mini quiz result?

Section 3 of 9

Daily Function + Pain Points

Which part of the day feels hardest right now?

Of the areas you selected, which feels like the biggest priority?

What usually happens right before things escalate?

What does escalation usually look like for your child?

How often do these hard moments happen?

How long does it usually take your child to recover once dysregulated?

Which statement feels MOST true about your current play setup?

What kind of play tends to last the longest right now?

When your child becomes dysregulated, what helps MOST consistently?

What have you already tried that helped, even a little?

What have you already tried that did NOT help?

What feels most exhausting for you as the parent/caregiver right now?

Section 4 of 9

Home Environment + Play Space Assessment

Which spaces does your child currently use for play?

Which space would you most like us to focus on first?

How are your child’s toys currently organized?

Which statement feels MOST true about your home environment right now?

Does your child currently have spaces specifically designed for the following?

What toys or activities currently get used MOST?

What toys or activities rarely get used?

What tends to happen with toys in your home?

What physical spaces does your child naturally gravitate toward?

What parts of the home seem to dysregulate your child most?

What parts of the home seem to help your child settle?

Are there any safety concerns in the current setup?

What are your biggest frustrations with cleanup or toy storage?

Are you open to toy rotation or reducing visible toys?

Are there items you do NOT want removed, rotated, or changed?

Section 5 of 9

Development + Play Capacity

This is not a clinical developmental assessment. This section helps identify what types of play environments may be the best fit right now.

How does your child usually begin play?

How long can your child usually stay engaged in play without adult help?

What helps your child stay engaged longer?

How does your child respond when play becomes challenging?

Which types of play does your child currently enjoy?

Does your child engage in pretend or symbolic play?

What does pretend play usually look like?

How flexible is your child during play?

How does your child handle cleanup?

What does your child do when they don’t know what to play?

Section 6 of 9

Sensory + Regulation Patterns

Which types of sensory input does your child seek?

Which types of sensory input does your child avoid or dislike?

What environments are hardest for your child?

What environments help your child feel most regulated?

What does your child’s body seem to need before they can focus?

After a hard moment, what helps your child come back to baseline?

What usually makes dysregulation worse?

Section 7 of 9

Connection, Independence + Family Flow

How often does your child seek adult participation in play?

What does your child usually want from you during play?

What kind of independent play would feel realistic and helpful for your family right now?

What makes independent play hardest right now?

What would make daily life feel easier for you?

Section 8 of 9

Parent Goals + Assessment Priorities

What are your top 3 goals for your child’s space or routine?

What would you most like your child to be able to do more easily?

What would YOU like to feel more confident about?

What is your budget comfort level for possible toy/environment changes?

Are you looking for recommendations that are more:

Are there any design preferences we should know?

Section 9 of 9

Photos + Final Context

Photo note: This form does not upload files directly. Please paste a link to a Google Drive, Dropbox, iCloud, or shared folder with photos/videos of your space. Natural, unedited photos are best — no need to clean first.

Photo or video folder link

What should we notice about these spaces?

Examples: where your child dumps toys, where they climb, where meltdowns happen, where cleanup gets hard, where they play best, what you want to change.

Is there anything important about your child that this form has not captured?

Are there any diagnoses, therapies, school supports, or developmental concerns you want us to be aware of?

Optional. This only helps us understand context. The Play Haven Assessment™ is not a diagnostic service and does not replace therapy, medical care, or developmental evaluation.

Are there any family routines, cultural values, or household realities we should consider when making recommendations?

What would make these recommendations feel truly helpful to you?

Thank you — your assessment has been submitted.

We’ll review your responses and photo/context information as we prepare your personalized Play Haven recommendations.

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