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SENSORY HAVEN DESIGN – FAMILY INTAKE QUESTIONNAIRE

Please complete this form so we can understand your child’s needs and design a sensory-friendly space tailored to them.

SECTION 1 — CHILD INFORMATION
SECTION 2 — SENSORY PROFILE
Primary sensory challenges
Sensory input your child seeks
Enjoys swinging
Yes
No
Enjoys climbing
Yes
No
Enjoys spinning
Yes
No
Enjoys deep pressure
Yes
No
Enjoys tactile play
Yes
No
Enjoys visual stimulation
Yes
No
Enjoys quiet, calming spaces
Yes
No
SECTION 3 — BEHAVIORAL AND EMOTIONAL NEEDS
SECTION 4 — DAILY ROUTINES AND HOME ENVIRONMENT
Preferred space style
SECTION 5 — SPACE DETAILS
Flooring type
Natural light level
SECTION 6 — EQUIPMENT PREFERENCES
Equipment you’re interested in
SECTION 7 — DESIGN PREFERENCES
Preferred aesthetic
SECTION 8 — FAMILY GOALS

Please upload images or videos of the room to help us better understand your space.

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