Iowa Family Chiropractic Pediatric Sensory Questionnaire
Please fill out the following questionnaire prior to your child’s appointment. Check the box if the statement is true for your child. Leave it blank if it is false, or if the statement does not apply.
Modulation
Over-responsiveness
Under-responsiveness
Sensory Seeking
Sensory Discrimination
Sensory-Based Motor Abilities
Social and Emotional
Internal Regulation
Submit
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