Children's Advocacy Centers of North Dakota
200 E. Main Street #301 * Bismarck, ND 58501
701-323-5626 * www.CACND.org
Email contact
 
Pre-Appointment Screening Tool 

It is important to ask questions prior to the initial appointment in order to better serve the child's needs. The below questions provide a guide for asking caregivers before initially interacting with a child. 

Click here to download the complete screening tool form.

Appointment Screening Tool
 
Patient name:_______________                                            Date:____________
 
 
Informant:_________________________Relationship:_____________________
 
Phone number:_____________________
 
 
1.      Is there anything I should know about your child before I talk with them?
 
 
2.      Does your child have a disability?  If yes does he/she receive services?
 
 
3.      Can you tell me what level your child functions at?
 
 
4.      What are your child’s support needs and what accommodations does he/she receive?
 
 
5.      What do I need to know to communicate with your child?
 
 
6.      Are there ways that they communicate other than words?
 
 
7.      How do you know when they are happy, hungry, etc.?
 
 
8.      Does he/she use any special device or equipment?
 
 
9.      Is your child sensitive to noises, sounds, lighting, smells or textures?
 
 
10.  What type of things are soothing to your child?
 
 
 
11.  Is there any actions, behaviors or routines that your child does that I need to be aware of?
 
 
12.  What are your child’s favorite activities/objects?
 
 
13.  About how long do you think your child be able to stay focused during his/her appointment?
 
 
14.  Does your child take any medications?  What are they for?
 
 
 
15.  What is the best time of the day for your child to have an appointment?
 
 
Right now we have the appointment scheduled @ __________ on ______________. 
Pre-Appointment Questions 


1. Is there anything I should know about your child before I talk with them?


2. Does your child have a disability? If yes does he/she receive services?

3. Can you tell me what level your child functions at?

4. What are your child’s support needs and what accommodations does he/she receive?

5. What do I need to know to communicate with your child?

6. Are there ways that they communicate other than words?

7. How do you know when they are happy, hungry, etc.?

8. Does he/she use any special device or equipment?

9. Is your child sensitive to noises, sounds, lighting, smells or textures?

10. What type of things are soothing to your child?

11. Is there any actions, behaviors or routines that your child does that I need to be aware of?

12. What are your child’s favorite activities/objects?

13. About how long do you think your child be able to stay focused during his/her appointment?

14. Does your child take any medications? What are they for?

15. What is the best time of the day for your child to have an appointment?
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