Special Care Questionnaire

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To prepare for an appointment, parents of children with special care requirements (including neurodiversity), can complete the questionnaire below.

Detailed answers will help the therapist better understand the child's needs and make a shared plan for their care in preparation for their dental appointment.

Child's full name *
Child's date of birth *
Describe your child's brushing routine including frequency, challenges, routine, etc. 0/500 Words
Describe your child's diet, including restictions, likes and dislikes, textures, concerns, etc. 0/500 Words
Describe your child's stims and sensory needs, including anything that makes your child overwhelmed and/or are drawn to (sound, smell, touch, etc). 0/500 Words
Describe how your child's communicates including their style of communication, signs of overwhelm/frustration, suggestions e.g. therapist to use short words & directions but no questions, etc. 0/500 Words
Describe your child's stims and sensory needs, including anything that makes your child overwhelmed and/or are drawn to (sound, smell, touch, etc. 0/500 Words
Describe your child's likes and dislikes, restrictions, concerns, etc. 0/500 Words
Describe any physical needs your child may have including physical impairments or behaviours. 0/500 Words
How would you like to approach the first dental appointment with your child e.g. social visit first, wait in the car, etc. Also what adjustments need to be made e.g."Please tell me before using something noisy, I would prefer if the lights are dimmed" 0/500 Words

Appointments