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* 1. Your Name, Your Child's Name, Child's Date of Birth, Name of Daycare

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* 2. Type your name if you consent to Thrive Speech Therapy screening your child

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* 3. Your Phone Number and e-mail address

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* 4. Does your child recognize words for common items like “cup”,
“shoe”, “book”, or “juice”

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* 5. Does your child enjoy games like peek-a-boo and patty cake?

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* 6. Does your child turn and look in the direction of sounds?

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* 7. Does your child begin to respond to requests (e.g. “Come here” or “Want more?”)

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* 8. Does your child produce babbling that has both long and short groups of sounds such as “tata upup bibibibi”

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* 9. Does your child use gestures to communicate (waving, holding arms to be picked up)

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* 10. Does your child imitate different speech sounds and has one or two words (hi, dog, dada, mama) around first birthday, although sounds may not be clear

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