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* 1. Does your child/teen struggle to sit on the toilet due to sensory issues?

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* 2. Is your child/teen on a sensory diet at home or school?

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* 3. Is your child/teen fully toilet trained?

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* 4. Is your child/teen

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* 5. Does your child/teen use a disc-o-sit or sensory cushion at home/school?

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* 6. If you answered No to question 4 is that because

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* 7. If your child/teen is not toilet trained or is struggling to complete the toileting task, why do you think that is? Check all that apply.

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* 8. Optional, If you answered Other please state a reason

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* 9. Optional: What is your child/teens primary disability diagnosis if applicable?

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