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* 1. Please enter your child's name, DOB and diagnosis.

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* 2. What therapies is your child currently enrolled in, or have done in the past?

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* 3. Does your child have an IEP?

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* 4. What are your biggest concerns regarding your child's diagnosis?

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* 5. On a scale of 1-10, what level is your anxiety regarding your child's diagnosis?

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