Autism Registry
What is your name? *
Your answer
What is your spouse’s name?
Your answer
What is your postal address?
Your answer
What is your e mail id?
Your answer
What your contact number?
Your answer
What is your child’s name?
Your answer
What is his/her age?
Your answer
At what age the child was diagnosed?
Your answer
What is he diagnosed as?
Your answer
What made you think that your child was different?
Your answer
Where was he diagnosed?
Your answer
What is he doing now?
Your answer
How can we help you?
Your answer
What do you think should be done to make things better for Autism affected?
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service