APD Screening Questionnaire

The APD screening questionnaire helps to identify symptoms of auditory processing deficits based on your experience in daily life. After you fill out this questionnaire, your responses will be reviewed by our audiologist and we will contact you with an evaluation of your responses. If your responses indicate that you may be a candidate for auditory processing disorder testing, we will discuss the results with you and if required, set up an appointment for a comprehensive APD assessment session.

The questionnaire consists of 50 questions, with each question corresponding to a different category of processing difficulty. The questions fall under one of the following categories:

AP	Auditory processing
ATT	Attention
LD	Learning Deficit
Lang	Language processing issues
AP/L	Auditory processing & Language processing
AP/ATT	Auditory processing & Attention
Seq/Org	Sequencing and Organizing
HLV	Hearing loss/ Auditory processing/ Auditory neuropathy ( Hearing issues of various kinds)

Please select the option for whether you (or your child, if you are filling this form on behalf of your child) exhibits the characteristics described by each question.

By clicking the Submit button, you consent to providing AudiPro Audiology Clinic with information about your/your child's perceived ability to respond to the various auditory, behavioural and environmental stimuli and circumstances as presented in the questionnaire. A copy of your responses along with a scored report will be sent to you and our audiologist, who will respond to your report for further enquiry and recommendations for assessment and audiological and/or other medical intervention.

All information collected on this form will be used strictly for evaluation purposes and will be stored in accordance with our data collection and storage policies. No part of this information will be shared with any external third party without express written or verbal consent of patient or patient's guardian (in case of minors), except unless required by law.