The Client Sensory Interview

Download the below form here:

Senseplanner Sensory Assesment Interview Download

SensePlanner Sensory Interview

Date of assessment: ____/____/____

Client Name: __________________________________ DOB: ___/___/___

Diagnosis: __________________________________________________________________________________________

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Reason for Assessment: __________________________________________________________________________________________

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Location of Assessment: __________________________________________________________________________________________

__________________________________________________________________________________________

People present during assessment:

__________________________________________________________________________________________

Goals: (list goals relevant to sensory assessment)

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General Health: (other general health conditions)

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Social Situation: (who does the client live with, number of siblings, any other social factors)

__________________________________________________________________________________________

Home Environment:

Home ownership:

Privately owned ☐ Housing NSW ☐ Private rental ☐ (agency details): ______________________

Other: ______________________________________________________________________________________

Property details:

House ☐ Single storey / Two storey Unit ☐ Town house ☐ Villa ☐

Length of tenure: ___________

Observations: (light, noise, presence of clutter)

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Informal Supports: (include carer details relationship to client, DOB, other roles performed by carer, employment status)

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Allied health/medical supports: (e.g. medical specialists, behaviour support practitioner, physio, EP, speech, music therapist, dietician, psych (include provider and frequency))

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Client’s weekly routine: (school, work, social interactions, regular and occasional activities)

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Sensory History:

Likes: Consider: Types of food? Textures? Clothes? Sounds? Music?
Dislikes: Consider: Types of food? Textures? Clothes? Sounds? Music?

Current and Previous Sensory Strategies used: (details of strategies, how long were they used, were they successful for a period of time then no longer successful)

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Sensory AT used by client:

(what AT does client currently use, what has been used successfully or unsuccessfully in the past)

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Behaviour During Assessment:

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Notes/Comments:

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Occupational therapist: _________________Signature: ________________________ Date: ___/___/___