SENSORY HISTORY FORM

FOR EACH QUESTION, CHOOSE THE OPTION THAT BEST DESCRIBES YOUR CHILD. (PLEASE COMPARE WITH OTHER CHILDREN YOU KNOW OF THE SAME AGE.)

QUESTIONS - TACTILE SENSATIONS

 

 Does your child:

QUESTIONS - AUDITORY SENSATIONS

 

 Does your child:

QUESTIONS - GUSTATORY SENSATIONS

 

 Does your child:

QUESTIONS - OLFACTORY SENSATIONS

 

 Does your child:

QUESTIONS - VISUAL SENSATIONS

 

 Does your child:

QUESTIONS - VESTIBULER SENSATIONS

 

 Does your child:

QUESTIONS - COORDINATION

 

 Does your child:

QUESTIONS - FEEDING

 

 Does your child: