Autism Assessment Pre-Assessment Questionnaire

If you have been asked to complete an Autism Assessment Pre-Assessment Questionnaire, please download and print the form below.

The questionnaire helps the clinician gather important information about developmental history, communication, social interaction, behaviours, interests and any sensory differences that may be relevant to an autism assessment. Completing the questionnaire as fully as possible will assist the assessment team in understanding your concerns and individual circumstances.

Parents, carers or guardians may complete the questionnaire on behalf of a child or young person, or provide additional information where appropriate.

Please bring the completed questionnaire with you to your appointment. If you are unable to print the form, please contact the surgery and a paper copy can be provided.

Please note: Completing this questionnaire does not confirm a diagnosis of Autism Spectrum Disorder (ASD). The information provided forms part of the assessment process and helps clinicians determine the most appropriate next steps.

For any questions regarding the questionnaire or the autism referral process, please contact the surgery reception team.

Download the Autism Assessment Patient/Parent Pre-Assessment Questionnaire below.