LEISURE Leisure Interest Survey Leisure Interest Active games / Sports  Hobbies and Clubs Spirituality   Activities with peers  Music TV/Video games /Computers    Arts and Crafts  Outdoor Activities  Other _____________________ (specify) Fitness / Health   Quiet / Solitary activities Leisure Comments: Do You Have a Special Interest or Talent? Do You Wish to Share This With Others?  No  Yes Special Interest Comments: What is Your Favorite Activity? How Do You Spend Your Free Time? With others By yourself Depends on situation Unknown     What Activities Do You Do When You are By Yourself? Activity Comments: (Clinician assessment - include recommendations) How Do You Usually React in Group Situations?  Join in  Leave group  Listen for a while, then join in  Quiet and watch  Unknown  Other _____________________________ (specify) Group Situation Comments: 2
LEISURE Leisure Interest Survey Leisure Interest  Active games / Sports  Activities with peers  Arts and Crafts  Fitness / Health  Hobbies and Clubs  Music  Outdoor Activities  Quiet / Solitary activities  Spirituality  TV/Video games /Computers  Other (specify) _____________________ Leisure Comments: Do You Have a Special Interest or Talent? Do You Wish to Share This With Others?  No  Yes Special Interest Comments: What is Your Favorite Activity? How Do You Spend Your Free Time?  With others  By yourself  Depends on situation  Unknown What Activities Do You Do When You are By Yourself? Activity Comments: (Clinician assessment - include recommendations) How Do You Usually React in Group Situations?  Join in  Leave group  Listen for a while, then join in  Quiet and watch  Unknown  Other (specify) _____________________________ Group Situation Comments: 2
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