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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. Does your child understand words for order (first, next, last) and words for time (yesterday, today)

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* 5. Does your child follow long multi-step directions (2-3 steps)

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* 6. Does you child say all speech sounds in words. May have
articulation errors on harder sounds (l, r, s, v, z,
ch, sh, th.) 

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* 7. Does your child use sentences with more than 1 verb, use adjectives, use adverbs, and use grammatically correct sentences?

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* 8. Does your child change communication based on environment/
listener (louder outside, shorter with young kids)?

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* 9. Does your child repeat sentences containing up to 9 words?

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* 10. Does your child know common opposites, define common objects, and count to 10 or above?

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