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info@theoascenter.com | (619) 431-5049

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Specialized Therapy Services

Specialized Therapy Services

Making Connections Happen

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Parent Questionnaire

If you have not enrolled your child yet, please click on the button below to enroll them first.

Enroll Your Child Here First

Do not complete the parent questionnaire until you have been prompted by our enrollment team.

Parent Questionnaire

(Please complete the form to the best of your ability and return it prior to your evaluation appointment. The evaluating therapist will review this form and may probe for additional information during the evaluation. Please include copies of related evaluations/progress reports and/or current IEP’s).

  • Specialized Therapy Services

  • MM slash DD slash YYYY
  • Family Information and Background

  • Developmental Milestones

  • Please fill out, to the best of your knowledge, the month/year of age at which your child first accomplished the following:
  • Turned OverStood (Alone) 
  • Sat Alone1st Word 
  • CrawledWalked (Alone) 
  • Babbled2 Words Together 
  • Drop files here or
    Max. file size: 50 MB.
    • Birth History

    • Mother age at the time of pregnancy:Length of labor: 
    • Birth weight:Apgar score: 
    • Multiple births yes/noDid the mother recieve prenatal care? 
    • Current Speech – Language – Hearing

    • Feeding and Development

    • School Experiences

    • Scheduling

    • *Please include dates/times

    The Oas Center & Specialized Therapy Services

    4204 Adams Ave
    A,
    San Diego, California 92116
    Phone: (619) 431-5049
    Email: info@theoascenter.com

    Specialized Therapy Services

    30 Corporate Park
    Suite 108,
    Irvine, California 92606
    Phone: (949) 508-5577
    Email: info@theoascenter.com
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