Adult Sensory Assessment Questionnaire
Please complete this questionnaire to help us understand your sensory processing patterns. Your responses will remain confidential.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Age
*
How often do you experience the following in daily life?
*
Rows
Never
Rarely
Sometimes
Often
Always
I am bothered by certain textures of clothing.
1
2
3
4
5
I am sensitive to loud or sudden noises.
6
7
8
9
10
I avoid certain foods because of their texture or taste.
11
12
13
14
15
I feel overwhelmed in crowded or brightly lit places.
16
17
18
19
20
I am easily distracted by background noises.
21
22
23
24
25
How would you rate your sensitivity to touch?
*
1
2
3
4
5
How would you rate your sensitivity to sound?
*
1
2
3
4
5
Which of the following best describes your reaction to strong smells?
*
I do not notice them
I notice them but they do not bother me
They sometimes bother me
They often bother me
Other
Which of the following best describes your response to movement (e.g., riding in a car, escalator, or amusement ride)?
*
I enjoy most movement activities
I am sometimes uncomfortable with certain movements
I avoid movement activities when possible
Other
Please indicate any sensory experiences that significantly impact your daily life:
Bright lights or visual patterns
Strong smells or odors
Loud or unexpected sounds
Certain food textures or tastes
Crowded or busy environments
Other
Please describe any additional sensory challenges or strengths you would like to share.
Would you like to be contacted for further discussion or support?
*
Yes
No
Submit Assessment
Should be Empty: