This resource is intended for therapists and child-support professionals. Use it within your training, scope, service procedures and local requirements.
Parent Intake Questionnaire for Child Therapy
A focused 12-page caregiver questionnaire covering presenting concerns, daily functioning, family and school context, strengths and therapy goals.
Parents and caregivers · Professional useInstant downloadZIP downloadEditable DOCX included
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Therapist-developed. Practice-informed. Carefully reviewed.
Every SafeSEL resource is developed and reviewed by a practicing therapist for clarity, practical usefulness, and age-appropriate language.
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About this resource
Ready to print and use.
A clear, professionally structured questionnaire for gathering parent and caregiver perspectives before or during child therapy intake. It covers current concerns, development, daily functioning, family and school context, previous support, strengths and hopes for therapy.
INCLUDED
12 pages supplied in four files: A4 PDF, US Letter PDF, editable A4 DOCX and editable US Letter DOCX. The package is delivered as one ZIP file for immediate download.
PROFESSIONAL SCOPE
This is an information-gathering template, not a diagnostic or standardized assessment instrument. Adapt it to your role, setting, consent process and jurisdiction.
LICENSE
For use by one purchasing practitioner in their own professional practice. Files may be adapted for that practitioner's workflow but may not be shared with other professionals, resold, sublicensed, placed in shared template libraries or redistributed as blank resources.
How to use it
Start small, then adapt from the response.
- Review the scope and choose the pages that fit the current clinical task.
- Use the selected form or worksheet within your own assessment, consent and safeguarding procedures.
- Record what changed and adapt the next step to the child, family and setting.
Before you use this resource.
Yes. Select only the parts that fit the current clinical task and adapt your explanation, pacing and follow-up. File editability depends on the formats listed on this product page.
No. SafeSEL resources are practice aids. Assessment, diagnosis, safeguarding, consent and documentation requirements remain the responsibility of the treating professional.