18 AND UNDER

INTAKE AND SCREENING

Is there a history of learning difficulties in the family?
Is this child enrolled in school?
Has the child repeated a grade?
Does the child receive extra help in reading at school?
Does the child receive extra help after school?

HOW WOULD YOU RATE YOUR CHILD'S...

School Grades
School Attendance
School Attitude
School Conduct

READING

Is your child experiencing reading difficulty?
Does your child know the letter sounds?
Is your child able to decode?
Does your child reverse letters?
Does your child transpose letters?
Is your child able to blend letter sounds?

WRITING, SPELLING, AND MATH

Does your child experience problems writing?
Is your child's writing legible?
Does your child reverse letters when writing?
Can your child write in both print and cursive?
Does your child have problems spelling?
Does your child have problems with Math?
Is your child on grade level for Math?
Does your child reverse numbers?

SPEECH

Does your child have speech problems?
Has your child ever received speech or language services?
Does your child have hearing problems?
Does your child have vision problems?
Which hand does your child prefer to write with?
Does your child have problems using his or her hands?
Does your child often fall while running or walking?
Does your child have problems understanding verbal directions?
Does your child have problems with verbal expression?

HEALTH

Does your child have any allergies?
Does your child have asthma?
Does your child have migraines?
Has your child been diagnosed with ADD?
Has your child been diagnosed with ADHD?
Are there any medical conditions we should be aware of?
Any problems during pregnancy or childbirth?
Has your child ever had lead poisoning?
Has your child ever had head injuries?
Has your child been diagnosed with emotional problems?
Has your child had any psychological or psychiatric evaluations?
Is the child on any medications?
Does your child receive any other treatment?

THE ROTUNDA

SUITE 310

711 W 40TH STREET

BALTIMORE, MD 21211

P   410 889 5487

F   410 889 5363

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All rights reserved.

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