Jeanne Holverstott, MS
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Sensory Experiences
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Sight
Are you especially sensitive to certain types of lights? If so, please specify what types of lights trigger your sensitivity.
Do you notice (visually) things other people don't seem to notice (i.e., patterns, small details, specific colors)? If so, please specify.
Do you enjoy or seek out certain visual stimuli? If so, please provide examples and why you enjoy/seek out each particular stimulus.
When did you recognize that you were visually sensitive or sought out/enjoyed certain visual stimuli?
Are you especially sensitive to lights? If so, what happens because of your sensitivity to light?
Hearing
Is your hearing especially sensitive? If so, what happens because of your sensitive hearing?
Has someone ever asked if you have hearing loss or recommended that you have your hearing tested? If so, please explain the circumstances.
Do certain sounds cause you physical pain? If so, specify the sounds and when you first noticed this physical pain.
Do you hear things other people don't seem to notice (e.g., electricity, very quiet sounds, high-pitched sounds)? If so, please specify.
Do you have a difficult time ignoring specific sounds that others seem to not notice or ignore? If so, please specify.
Do complicated or busy soundscapes overwhelm you or make it hard for you to focus? (e.g., lots of people talking at once, places with background music playing, someone talking with the TV on)? If so, please specify.
Do you enjoy or seek out certain sounds? If so, please specify.
Taste
Is your sense of taste especially sensitive? If so, when did you first recognize this?
Are there certain foods you can’t stand because of the texture? If so, please specify the food and the texture.
Do you prefer bland foods? If so, please specify the foods.
Do things seem spicy to you that don’t seem spicy to other people? If so, how did you discover this?
Are you especially sensitive to temperatures of hot or cold food or drinks? If so, please specify.
Do you enjoy or seek out certain flavors? If so, please specify the flavors.
Smell
Is your sense of smell especially sensitive?
Do you notice smells that others don’t seem to notice? If so, please specify.
Do you often describe smells as "strong"? If so, please specify those smells and what happens when you are around those odors.
Do you enjoy or seek out smells? If so, please specify.
Touch
Is your sense of touch especially sensitive? If so, when did you realize how sensitive you were?
Do you choose clothes based on how they feel rather than what they look like?
Are you very particular about how your clothes fit (e.g., loose/baggy/tight/snug)? If so, please specify.
Will you only wear clothes made of certain fabrics? If so, what fabrics do you seek out and what fabrics do you avoid?
Are you not able to wear jewelry/accessories because of how it feels?
Do you dislike being touched? If so, please specify.
Do you enjoy the sensation of being squished/hugged/having deep pressure applied to you? If so, please specify.
Do you enjoy or seek out certain textures? If so, what textures and why?
Are you especially sensitive to movement? If so, what happens to you physically?
Jeanne Holverstott, MS
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