INPP® screening · before your assessment

Screening questionnaire

This questionnaire gathers background history used alongside your INPP® assessment. It covers early development, nutrition-related symptoms and listening/auditory patterns. It takes most families 15 to 20 minutes.

Completing for a child Completing for an adult

Some questions below relate to early childhood and developmental history that you may not remember or know for certain. That's completely fine. Choose “I do not know” or leave a question blank wherever that applies, and just complete what you can.

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Details

Child & family details

Name of child

Date of birth

Address

Parent / Guardian

Tel no

Mobile no

Has a diagnosis been given at any time?

Is your child currently taking any prescribed medication? Please specify:

What investigations/interventions has your child received in the past?

What are the presenting symptoms?

Part 1: Neurological

Historical & infancy

Part 2: Nutritional

Screening questionnaire (Sheil)

Has your child suffered from any of the following at regular intervals? Please tick as appropriate.

Part 3: Auditory (Madaule)

Developmental history & listening

Finally

How did you hear of INPP®?

Date questionnaire completed

Please add any additional information relevant to your child’s presenting problems

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Submitted

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The INPP Screening Questionnaire, devised by Blythe and McGlown © 1979, 1998, amended Goddard Blythe 2006. Nutritional section after Sheil. Auditory section after Madaule. For use within Helping Hand / INPP® UK assessments only.