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* 1. Your Name

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* 2. Your Child's Name and Date of Birth

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* 3. Your Phone Number and e-mail address

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* 4. Your Child's Gender

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* 5. Does your child startle to loud sounds?

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* 6. Does your child quiet down or smile and seem to recognize familiar voices when spoken to?

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* 7. Does your child decrease or increase sucking behavior in response to sound?

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* 8. Does your child make pleasure sounds (cooing/gooing)?

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* 9. Does your child cry differently for different needs?

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* 10. Does your child smile when they see a familiar person?

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