Parent Survey
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What is your name? *
What is your email address? *
What is your child's name? *
What is your child's date of birth? *
Is your child male or female? *
What grade is your child currently in? If summer, please list the grade your child will be in during the next school year. *
How are you currently feeling about your child's experience in school? Please include information about current ability, current strengths and weaknesses, and any feelings your child has about school. *
What interventions, if any, have you tried so far? Please include any services received from Dyslexia Treaters. Please also include dates of intervention services. *
On a scale from 1 to 10, how familiar are you with dyslexia? *
Not familiar
Very familiar
On a scale from 1 to 10, how familiar are you with Orton-Gillingham intervention methods? *
Not familiar
Very familiar
Which dyslexia remediation programs are you familiar with? (Check all that apply) *
What are your goals for your child? *
Please list at least three times you can have a zoom meeting with me in the next 2 weeks. *
Is there any other information you would like me to know about you or your child? *
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