Hello amazing parents!
Filling out this form will be of great help to us. You can do this completely anonymously too! The data is for internal use only and will help us potentially help parents of children with autism someday soon. However, if you do want to stay in touch with us as we progress and have more answers, then make sure to fill out your details at the end.

Remember anyone with a child 2-10 years old can fill out the form ASD, ADHD, depression, anxiety or none of the above. Fill out separately for each child you have.

Also check out ANeustart.com if you would like to learn more.

Maya Lebow, PhD and Yael Kuperman RD, PhD
Co-Founders of ANeustart
"Putting brain development back on track. Imagine."
For more about us:
Sex of child at birth
Clear selection
Date of Birth
Current weight estimation and unit measurement (for example 16.5kg or 16.5lbs)
Current height and unit measurement (estimation, for example 100 cm or 100 inches )
The child was diagnosed by a professional with *
Other Diagnosis
At what age was the child diagnosed? *
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