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Speech & Language Development Screening Form
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Name
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Mobile Number
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Email
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Age
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Gender
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Male
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Any Prior Diagnosis (if any):
How clear is your child’s speech?
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1
2
3
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5
(1 = Not clear at all, 5 = Very clear)
Maximum number of words your child can say in a sentence:
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Single words only
2–3 words
3–5 words
Full sentences
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