Screening Questionnaire



The Screening Questionnaire provides information on the individual’s developmental history and current presenting difficulties.

Options are presented below to enable you to complete the questionnaire before meeting us. You can complete on-line, download and print out the questionnaire in Word format or request that we post out a copy to you. If you have any problems or queries with the screening questionnaires please contact us on 0114 2451502 or via email at info@kinesisconsultancy.com

Option 1 – Send us an online questionnaire

Go to Child Screening Questionnaire
Go to Adult Screening Questionnaire

Option 2 – Download, print and send to us

Download Child Screening Questionnaire (Word document)
Download Adult Screening Questionnaire (Word document)

Option 3 – If you would like us to post a Screening Questionnaire to you

Please complete the enquiry form below



The Screening Questionnaire originates from the British Journal of Occupational Therapy, Goddard S, Hyland D, October 1988 and An Organic basis For Neurosis and Educational difficulties, Blythe P, /McGlown, 1979.