Parents of Children with Autism Survey

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1. Has your child received a diagnosis of autism from a medical practitioner?

Has your child received a diagnosis of autism from a medical practitioner?   Yes No

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2. Is your child between 3 to 16 years of age?

Is your child between 3 to 16 years of age?   Yes No

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3. Do you live with your spouse and your child with autism on a consistent basis within the Bay Area of Northern California?

Do you live with your spouse and your child with autism on a consistent basis within the Bay Area of Northern California?   Yes No