NDIS Intake Questionnaire NDIS Intake Questionnaire 1. About the Participant Participant's Full Name: Participant's Age: Primary Diagnosis (if any): Date and By Whom diagnosis was made: Any additional or suspected diagnoses: Has the participant recently undergone any assessments? YesNo If yes, please list the assessments and outcomes: 2. Behaviour & Safety Does the participant currently have a Behaviour Support Plan (BSP)? YesNo If no: Are you planning to obtain one or currently working with a Positive Behaviour Support practitioner? Are there any behaviours of concern that may impact therapy sessions? (e.g., aggression, absconding, self-injury, intolerance of transitions, emotional distress) Has the participant received previous behavioural support? YesNo If yes, what strategies were implemented, and what has/hasn’t been helpful? 3. Previous Therapy History Has the participant engaged in therapy services previously? YesNo If yes, please list types and frequency (e.g., OT, Speech, Physio, Psych, Exercise Physiology, AHA support): What worked well in past therapy experiences? What challenges or barriers were experienced? (e.g., attendance, communication, goals, behaviour, progress) Has the participant had any gaps or withdrawals from therapy? YesNo If yes, what were the reasons? 4. Capacity & Support Network Who is involved in supporting the participant day-to-day? (e.g., parents/carers, partners, siblings, support workers, guardians, teachers, house staff) Do you have a current support network to help with therapy tasks and follow-through between sessions? How confident do you feel supporting therapy recommendations between sessions? Very confidentSomewhat confidentUnsureNot confident Please provide more detail if helpful: Are there any circumstances that may affect your ability to participate consistently in therapy? (e.g., transport, schedules, shift-work, medical needs, fatigue, competing appointments) 5. Collaboration & Engagement Are you willing and able to take an active role in the participant’s therapy? YesSometimes / dependsUnsure Please explain: What are your expectations of therapy and your therapist? How do you prefer to receive communication and feedback from the therapy team? (e.g., email, phone, written notes, in-session discussion) Are there any cultural, communication, sensory, or personal preferences we should be aware of to best support you/the participant? 6. Goals & Priorities Key goals you hope therapy will support over the next 3–6 months: What would meaningful progress look like? 7. Additional Information Is there anything else you would like us to know before beginning therapy?
