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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 your child being screened by Thrive Speech Therapy 

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* 3. Your Phone Number and e-mail address

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* 4. Does your child have a vocabulary of approximately 5-20 words?

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* 5. Does your child use some repeating of the same word or phase repeatedly? (ball, ball, ball)

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* 6. Does your child use jargon (their own language) with inflection?

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* 7. Does your child follow simple commands? ("roll the ball")

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* 8. Does your child point to a few body parts when asked?

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* 9. Does your child listen to simple stories, songs, and rhymes?

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* 10. Does your child use different consonant sounds at the beginning of words?

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