ENSURING YOUR COMFORT

Sensory Session Questionnaire

We offer sensory sessions for individuals and families who need extra time and care. We want to ensure a welcoming environment where every loved one feels comfortable and respected.

Please fill out this questionnaire prior to booking so we can ensure the correct fit for your needs.

First Name

Last Name

Phone

What are the names of your family members and their ages? (Parents do not have to give me their ages.)

Do you have a specific person you'd like us to take a little extra care with? (Ex. Sensory needs, time to adjust, etc.)

What are some things we can do to make your loved one most comfortable?

Are there any physical concerns we should be careful with during your session? (Ex. A wheelchair, concerns with eyesight, certain poses we should avoid that could make anyone uncomfortable physically, etc.)

Are there any health concerns we should know about? (Ex. Should we wear a mask because of a weaker immune system or to stay healthy for an upcoming surgery, etc.)

Does anyone have any dietary restrictions? (We have Christmas cookies available for fun Christmas cookie pictures!)

What are all of your children's interests?

Tell me about your family! Use as many or as little words as you'd like!

What is your main goal for this session?

What are you most concerned about for your session?

Anything else you'd like me to know?

ENSURING YOUR COMFORT

Sensory Session Questionnaire

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