Name
Email Address
Phone
Is your child 2 years of age and can he/she say 30 – 50 words Can your child point at objects when asked?
Yes
No
Can your child point at objects when asked?
Yes
No
Does your exhibit vacant stare?
Yes
No
Can your child follow simple verbal instruction?
Yes
No
Are there any specific sounds or words the child struggles to pronounce?
Yes
No
Does your child have any fluency issues?
Yes
No
Has your child undergone any speech and language therapy before?
Yes
No
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