Body Parts Communication Cards Questionnaire
Body Parts Communication Cards Questionnaire
Respondent Name
*
First Name
Last Name
Role or Relationship to the User
*
Please Select
Self
Parent or Guardian
Therapist
Teacher or Educator
Support Staff
Healthcare Professional
Other
Organization or Setting Name
*
Primary Purpose for Using the Communication Cards
*
Please Select
Daily Communication
Medical or Therapy Sessions
Classroom or Educational Use
Home Use
Behavioral Support
Other
Body Parts or Body Areas to Include
*
Head
Face
Eyes
Ears
Mouth
Neck
Shoulders
Arms
Hands
Chest
Back
Stomach
Legs
Feet
Other
Communication Need or Message Type for the Cards
*
Pain
Discomfort
Pointing/Indicating
Hygiene
Movement
Attention
Comfort
Help/Assistance
Medical Needs
Other
Preferred Card Style or Format
*
Picture Symbols
Text Only
Photo Images
Icons
Mixed/Combination
Other
Accessibility Requirements or Communication Preferences
*
Large Print
High Contrast
Tactile Cards
Braille
Simplified Language
Visual Supports
Audio Output
Other
Notes on Customization or Special Instructions
Preferred Follow-up Contact Method
*
Email
Phone
Contact Details (Email or Phone, depending on your selected method)
*
Body Parts Communication Cards Questionnaire
Should be Empty: