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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. Your Child's Gender

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* 5. Does your child move their eyes in direction to sounds?

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* 6. Does your child respond to changes in your tone of voice?

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* 7. Does your child notice toys that make sound?

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* 8. Does your child make babbling sounds more speech-like with many different sounds (including p, b, and m)

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* 9. Is your child beginning to use intonation during vocalizations, chuckle and laugh, and vocalize excitement/displeasure? 

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* 10. Does your child make gurgling sounds when left alone and when
playing with adults?

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