Form for Establishing a Routine
You can complete the highlighted fields on this form online and then print the form for easy reference. Only
text that is visible on the form is printed; scrolled text will not print. Any text you enter into these fields will
be cleared when you close the form; you cannot save it.
Use this form to problem-solve and establish a routine.
What is the problem?
What time of day or activity can be used to help you remember?
What are the steps in the routine that you need to make into a habit?
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What will you use to remind you to follow the routine?
We will keep track of the number of times you follow the routine by:
Plan ways to reward your child for each success. Create bonus rewards for a day in which your child
remembers and completes approximately 90% to 100% of a routine.
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information.
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