Sensory Questionnaire

  • How to complete this questionnaire

  • Thank you for taking the time to complete this questionnaire. Your responses will provide Kids First’s pediatric professionals with important insights into your child’s personality, needs, strengths and challenges.

  • To complete this questionnaire, simply choose one option that MOST ACCURATELY describes your child’s reactions to each scenario.

  • Please respond to every statement.

  • If you are unable to comment because you have not observed the behaviour or believe that it does not apply to your child, please choose ‘Not Observed’.

  • Your options are:

  • 1. Never

    Your child never responds in this manner to the situation described

  • 2. Approximately 25% of the time

    Your child responds in this way on about 25% of occasions

  • 3. Approximately 50% of the time

    Your child responds in this way on about 50% of occasions

  • 4. Approximately 75% of the time

    Your child responds in this way on about 75% of occasions

  • 5. Always

    Your child responds in this way on about 100% of occasions

  • 6. Not observed

    You have not seen your child respond in this way at any time.

  • If you have additional information to share with us, please use the ‘Comments’ box at the end of each section.

  • All information that you provide will remain confidential and will be used solely by our therapists to better understand and meet your child's clinical needs.

  • Background information:

  • DD slash MM slash YYYY
  • Auditory Processing

  • Visual Processing

  • Vestibular Processing

  • Touch Processing

  • Multi-sensory Processing

  • Oral Sensory Processing

  • Endurance/Tone

  • Behaviour and Emotional Responses

  • This field is for validation purposes and should be left unchanged.