Please indicate at what age your child reached the following milestones:
How does your child get along with:
If you provide your email address, we may contact you via email to send reports, and general correspondence. Emails are sent from our secure system; we will not send health information if you request us not to do so.
The information provided on this questionnaire is current and correct to the best of my knowledge, and I hereby give my permission to the doctors and therapists at Doctors Vision Centres Vision Therapy to treat my child.