Get Started. All information are kept confidential. "*" indicates required fields Tick the following signs and symptomsSpeech & Language Concerns: Fewer than 20 words by age 3, 100 words by age 4, or 250 words by age 5. Difficulty naming familiar objects or expressing basic needs. Limited variety of words used (mostly nouns and pronouns). Rare use of verbs or adjectives. Mostly uses single words or short phrases at age 4. Difficulty forming simple questions or statements (e.g., "Want juice?" instead of "Can I have some juice?"). Struggles with basic sentence structure (subject-verb-object). Difficulty combining different phrases into complex sentences. Speech not easily understood by strangers even after repetition. Omission or substitution of sounds (e.g., "bwana" for "banana"). Difficulty with word endings ("cat" instead of "cats"). Needs repeated or simplified instructions to follow basic directions. Struggles with multi-step commands or complex instructions. Difficulty understanding stories or instructions that require basic inference. Motor Skills Concerns: Awkward or unsteady walking, frequent falls. Difficulty running, jumping, climbing stairs, or hopping on one foot. Delays in kicking a ball or catching with coordination. Difficulty balancing or maintaining posture. Awkward or jerky movements. Clumsy hand movements, difficulty holding utensils or manipulating small objects. Challenges with writing, drawing, or cutting with scissors. Difficulty buttoning clothes, tying shoelaces, or zipping zippers. Poor hand-eye coordination. Messy eating due to fine motor difficulties. Social and Emotional Concerns: Prefers solitary play or avoids interaction with other children. Difficulty making eye contact, initiating conversations, or sharing toys. May not understand social cues or rules of play (e.g., turn-taking in games). Difficulty reading facial expressions or body language. Limited pretend play or social imagination. Frequent meltdowns, difficulty calming down after emotional outbursts. May react disproportionately to frustration or minor setbacks. Difficulty expressing emotions verbally or through appropriate channels (e.g., hitting instead of talking). Frequent whining, crying, or clinging behavior. Difficulty adjusting to new situations or changes in routine. Cognitive Ability Struggles with simple puzzles or games that require basic problem-solving skills. Difficulty figuring out how to open toys, solve everyday challenges, or adapt to new situations. Relies heavily on adult assistance for problem-solving tasks. Short attention span, easily distractible. Difficulty focusing on tasks for more than a few minutes. Frequently fidgets or wanders around, unable to sustain focus. Difficulty remembering recent events, instructions, or routines. May require constant reminders or repetition to grasp concepts or follow directions. Difficulty recalling names or information learned previously. Limited understanding of basic concepts like counting (beyond 10), sorting by color or shape, or understanding time (morning/afternoon/night). Difficulty with basic spatial awareness or understanding of cause-and u0002effect relationships. Additional Concerns Persistent refusal to eat, limited variety of preferred foods, picky eating. Difficulty chewing, swallowing, or expressing hunger or satiety cues. Overreaction or underreaction to sounds, textures, or touch. May avoid certain environments or activities due to sensory sensitivities. Persistent nighttime wetting beyond age 5, even with toilet training attempts Please provide more information or express any specific concerns you may have so that we can offer better assistance for your child. (Optional)Child's HistoryBirth History*- premature birth, low birth weight, c-section, assisted delivery, neonatal complications, genetic conditionsNoYesDetails of Birth History*-list the birth history Medical History*- previous illnesses and surgeries, allergies and chronic health conditions, medications currently taken, hospitalizations and any related diagnosesNoYesDetails of Medical History*-list the medical history Developmental Conditions*Has your child been diagnosed with any developmental conditions?NoYesDetails of Developmental Conditions*-provide details of developmental conditions Mental Health Conditions*Has your child been diagnosed with any mental health conditions?NoYesDetails of Mental Health Conditions*-provide details of mental health conditions History of Head Injury*Has your child had a head injury before? Concussions, car accidents, falls at home, bumps on the head that did not warrant medical attention, sports injuries, incidents that involved head traumaNoYesDetails of Head Injury*-provide details of head injury ProfileParent's Name* Contact Number*Child's Name* Age*Supplementary Information (Optional)Max. file size: 256 MB.Please upload reports (e.g. psychological report, medical report) here if you wish to supplement the application with with observations/reports done by other professionals.AvailabilityPreferred Appointment Day(s) I prefer a call first Mon Tue Wed Thu Fri Sat Sun Multiple choices allowedPreferred Appointment Timings Please key in your available timings for the preferred day.Information Use and Consent* By submitting this form, I have read and understood the statements below. I also consent to the collection and use of the submitted information. 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