Family Autism History Questionnaire Form
Please complete this questionnaire to help us understand your family's autism history. Your responses will provide important context for support and analysis.
Your relationship to the person with autism
*
Please Select
Parent
Sibling
Grandparent
Aunt/Uncle
Cousin
Other
Has anyone in your family been diagnosed with autism?
*
Yes
No
Not sure
Which family members have been diagnosed with autism? (Select all that apply)
Parent
Sibling
Grandparent
Aunt/Uncle
Cousin
Other
Approximate age at diagnosis (if known)
Are there any known genetic or medical conditions in the family?
Yes
No
Not sure
If yes, please specify the condition(s)
Have any family members exhibited traits commonly associated with autism (without a formal diagnosis)?
Yes
No
Not sure
Please describe any observed traits or relevant family history
Country or region of your family
Any additional context or comments
Submit
Should be Empty: