Parent's Name *

First Name

Last Name

Phone *

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Does your child have a vocabulary of nearly 2,000 words?

Yes

No

Not Sure

Does your child combine 5-6 words to create sentences?

Yes

No

Not Sure

Does your child know and use spatial relations such as on the bottom, above, and nearby?

Yes

No

Not Sure

Do others understand 100% of what your child says?

Yes

No

Not Sure

Does your child communicate easily with other children and adults?

Yes

No

Not Sure

Does your child enjoy reading stories and retelling them?

Yes

No

Not Sure

Does your child use most sounds correctly with the exception of a few like: TH, CH, and R?

Yes

No

Not Sure