Discovery Questionnaire

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A Note On Confidentiality

Your parenting story is a personal one.

The information you provide will be kept confidential, and I will only use to help me understand your child and your family situation. The information will also help me tailor my support in a way that meets your family's needs.

Please have a read of my Privacy Policy for more details on how your information will be used and stored, as well as your rights.
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Full Name*
First Name
Last Name
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Email*
example@example.com
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The best telephone number to reach you on
Area Code
Phone Number
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Child's name and age
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Who lives at home with you and your child?Please state who lives at home and ages of siblings (if applicable). It would be helpful to also include any sibilings who live outside the home, and any other family members important in your child's life and how often they see them.
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What are your main concerns?Please describe the main issues you are struggling with.
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How long have these difficulties been going on?It's okay if you don't know exactly. You can just say whether it's recent (e.g. a few weeks) or has been going on for a long time (e.g. more than 5-6 months).
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Have you had similar difficulties in the past?If yes, please describe what things were like then and how they were resolved.
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Have you or your child received any support from services?Please mention any support you or your child have received, either in the past or currently. For example, Speech and Language Therapy, Occupational Therapy, Triple P, etc.
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What strategies have you tried that you feel were helpful?Please mention any strategies you can think of that seem to be helpful or have been helpful in the past. Sometimes things work for a short period of time, then stop. It's helpful to include those that have stopped working as well as those that are working.
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What strategies have your tired that haven't worked?Please list any strategies that you have tried that haven't worked and what happened when they were tried.
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What do you hope to gain from working with me?For example, what sort of help are you looking for? What outcome would like to achieve?
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Pregnancy and birthPlease tell me a little bit about your pregnancy and birth with your child. For example, where there any concerns or complications during your pregnancy and birth? Was your child born early or late? Where there any health concerns after the birth for you or your child?
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You child's healthHow would you describe your child's health as a baby? As a toddler? Currently? Does your child have any diagnoses? Does your child have any known allergies?
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The early daysPlease describe briefly the first few weeks and months with your child. For example, did he or she fall easily into feeding and sleep routines? Would you describe him or her as a happy baby most of the time, or was he or she difficult to settle? Did they coo and babble? Etc.
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The toddler yearsPlease describe your child as a toddler. For example, what was their activity levels like? What was their ability to pay attention and concentrate like? What did they like to play with? How did they get on with peers and adults? How did toilet training go?
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Developmental milestonesDid you have any concerns about your child's development? How old was your child when he or she rolled over? Crawled? Walked? Started speaking in 1-2 word sentences? Started speaking in longer sentences?
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Current sleepHow would you describe your child's sleep? Any difficulties? If there are any difficulties, what is your bedtime routine like?
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Current eatingHow would your describe your child's eating? Any concerns?
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Current relationships with peers and adultsHow would you describe your child's relationships with peers and adults? Any concerns?
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Current attention and focusHow would you describe your child's ability to pay attention and focus? For example, how long can he or she stay focused on something he or she likes doing? How long can he or she stay focused on something they don't like doing?
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Current interestsWhat does your child like doing? What sorts of things motivates him or her?
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Current strengthsWhat would you say your child's strengths were? What are they good at?
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Is there anything I haven't asked that you think it's important for me to know?
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How would you describe your child's temperament?Some children are pretty relaxed and get used to new situations easily, while others take some time to 'warm up'. Other children are more difficult and seem more sensitive than other children.
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