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Parent's First & Last Name

Child's First Name

Child's Date of Birth

Does your child have autism spectrum disorder (ASD)? No ASD Suspected ASD Diagnosed

Does your child hear any language besides English on a regular basis? No, my child only hears English. Yes, my child hears multiple languages on a regular basis.

Email Address

Telephone Number

Home City

How did you hear about us? (optional)

Any additional questions or comments? (optional)

Lingo Lab Department of Communicative Sciences and Disorders

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For Families