Symptoms Form
Do you recognize any of these symptoms in your child? Problems in one or more of these areas could mean a learning disability.

We want to help address the cause of the problem. Check the areas that apply and submit the form so we can be of further assistance to you.

Parent Name
Your answer
Parent Email
Your answer
Parent Phone
Your answer
Address
Your answer
City
Your answer
State
Your answer
Zip
Your answer
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