Sensory Processing Concerns Intake
Individual Information
Full Name
Date of Birth
Parent/Caregiver Name
Contact Email
Sensory Concerns Overview
Main Sensory Concerns
Known Sensory Triggers
Coping Strategies Used
Sensory Profile
Visual Sensitivities
Auditory Sensitivities
Tactile (Touch) Sensitivities
Taste/Smell Sensitivities
Movement/Balance Concerns
Daily Function Impact
How do sensory issues impact daily participation?
Affected Activities (e.g., school, home, community)
Additional Information
Other Relevant Information