Autism Client Questionnaire

Autism Client Questionnaire

You are?

GP Practice Name

Your Autism

Have you been diagnosed?
If yes, with which?
Diagnosed by who?
If don’t know the exact year, approx is suitable

Have you got a history of a neuro-developmental conditions

History – Multi-Select

Your Autistic Traits

Communication – Multi-Select

How, Does Autism Effect You?

Behaviours- Multi-Select

How Does Autism Impact You?

Impact – Multi-Select
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