Autism Spectrum Mental Health Screening
Full Name
Age
Gender
Male
Female
Non-Binary
Other
Prefer Not to Say
Do you often experience difficulty with social interactions?
Yes
No
Do you have repetitive behaviors or routines?
Yes
No
Do you feel sensitive to certain sounds, textures, or lights?
Yes
No
Do you find it challenging to adjust to changes in your routine?
Yes
No
Do you have intense interests in specific topics?
Yes
No
Additional Comments