Before we start, we have a few questions to get to know more about you and your child.

What's your name?

First Name *

Last Name *

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How can we contact you?

Email *

Phone *

How old is your child? *

Does your child reacts to loud sounds?

Yes

No

Does your child calm down or smiles when spoken to?

Yes

No

Does your child recognize your voice and calms down if crying?

Yes

No

When feeding, does your child start or stop sucking in response to sound?

Yes

No

Does your child coo and make pleasure sounds?

Yes

No

Does your child have a special way of crying for different needs?

Yes

No

Does your child smile when he or she sees you? *

Yes

No

Does your child follow sounds with his or her eyes? *

Yes

No

Does your child respond to changes in the tone of your voice? *

Yes

No

Does your child notice toys that make sounds? *

Yes

No

Does your child pay attention to music? *

Yes

No

Does your child babble in a speech-like way and uses many different sounds, including sounds that begin with p, b, and m? *

Yes

No

Does your child laugh? *

Yes

No

Does your child babble when excited or unhappy? *

Yes

No

Does your child make gurgling sounds when alone or playing with you? *

Yes

No

This is not a test.