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Child / Teen Tic Intake Form (Parent Completed)

CHILD / TEEN TIC INTAKE (Parent Completed)

Welcome to TicTock Therapy


We specialise in tic and Tourette-related presentations using a structured, evidence-informed approach focused on nervous system regulation, tic mapping, and skill development.

All families begin with this intake form so we can provide a clinically informed recommendation within 48 hours.

SECTION 1 – Child Information

Date of birth
Day
Month
Year
Multi-line address

SECTION 2 – Presenting Concerns

When are tics most noticeable?

SECTION 3 – Premonitory Urge & Suppression

SECTION 4 – Emotional & Nervous System Profile

Please indicate if present:

SECTION 5 – Neurodevelopmental & Medical History

Diagnosis (if any):
Family history of:

SECTION 6 – Impact

SECTION 7 – Goals

SECTION 8 – Commitment

Our approach typically begins with a structured 6-session foundation programme. Are you willing to commit to a structured programme?
Yes
Unsure
Not at this stage
Image of Sarah who has brown hair facing the camera smiling, she is wearing a black top, behind her is TicTock therapy HQ

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'Educate yourself enough to feel Empowered, so you can Advocate for you/ your child.'

Here at Tictock Therapy, we take pride in being a disability-friendly organisation. We are constantly learning and adjusting our services. We work with a range of professionals and want to be inclusive to everybody. If you or your child feels that our website or any of our services doesn’t meet your accessibility needs, please do not hesitate to let one of the team know and we will happily make a Reasonable Adjustment where possible!

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