Special care questionnaire

Complete this questionnaire to prepare for an appointment for children with special care requirements (including neurodiversity).

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.

Parent's name

Contact phone number

Child's full name

Child's date of birth

Describe your child's brushing routine, for example frequency, challenges, routine.

Describe your child's diet including restrictions, likes and dislikes, textures, concerns.

Describe how your child communicates including their style of communication, signs of overwhelm or frustration, suggestions, for example, therapist to use short words and directions but no questions.

Describe your child's stims and sensory needs including anything that makes your child overwhelmed and things they are drawn to, for example, sound, smell and touch.

Describe your child's like and dislikes, restrictions, concerns.

Describe any physical needs your child may have including physical impairments or behaviours.

How would you like to approach the first dental appointment with your child, for example, social visit first, wait in the car.

What adjustments need to be made, for example, "Please tell me before using something noisy, I would prefer the lights are dimmed."

Health topics

Book a vaccine

Hospitals and services

Feedback about our hospitals

Which service should I use?

Online and phone

Online GP care

About us

Health targets

Latest news and media releases

Publications

Feedback about our hospitals