Online Background Questionnaire
Our background questionnaire (child version only) is now available to complete confidentially right here on the this page. You will always be redirected back to this page after each section, so you can take a break or keep on going. Be sure to submit all 10 sections of the questionnaire. Please allow one to two hours to complete the entire questionnaire.
Important note: You won't be able to save your progress, so be sure to complete each section in full before clicking "Submit" at the bottom.
Click on a section link below to get started. If you are prompted for a password, enter NSI2013 to access each section.
Section 1: Contact and Demographic Information
Section 2: Presenting Situation
Section 3: Social and Behavioral Checklist
Section 4: Education and School History
Section 5: Evaluations and Services
Section 6: Developmental History
Section 7: Medical History
Section 8: Family Medical History
Section 9: Behavior and Discipline
Section 10: Other Information
If for any reason you require more space than has been made available to you on this online questionnaire, please feel free to send additional information via email to [email protected]. If you need to make corrections after you submit a section, you can email the corrections to us directly or submit any of the sections a second time by selecting the corresponding link on the this page.
Important note: You won't be able to save your progress, so be sure to complete each section in full before clicking "Submit" at the bottom.
Click on a section link below to get started. If you are prompted for a password, enter NSI2013 to access each section.
Section 1: Contact and Demographic Information
Section 2: Presenting Situation
Section 3: Social and Behavioral Checklist
Section 4: Education and School History
Section 5: Evaluations and Services
Section 6: Developmental History
Section 7: Medical History
Section 8: Family Medical History
Section 9: Behavior and Discipline
Section 10: Other Information
If for any reason you require more space than has been made available to you on this online questionnaire, please feel free to send additional information via email to [email protected]. If you need to make corrections after you submit a section, you can email the corrections to us directly or submit any of the sections a second time by selecting the corresponding link on the this page.