Autism and other mental health care treatment contact Manushyaa Blossom Multispeciality Siddha Clinic

Autism Assessment Form

For details of the content refer Autism assessment Guidelines document (pdf) in Autism Document Reference folder

Dear Parents

Manushyaa Blossom aims to provide the best treatment and services to your family. Please spare some of your valuable time to complete this form (Assessment of Autism by Parents) Parent’s assessment not only helps to gauge the degree of Parent’s satisfaction with our treatment and services but also helps us to identify, rectify and improve our services to the best of our ability.

I. SOCIAL RELATIONSHIP AND RECIPROCITY

II. EMOTIONAL RESPONSIVENESS

III. SPEECH-LANGUAGE AND COMMUNICATION

IV. BEHAVIOR PATTERNS

V. SENSORY ASPECTS

VI. COGNITIVE COMPONENT

VII. OTHER HEALTH-RELATED OBSERVATIONS

The above informations submitted are true to best of my knowledge

Please Note:

*All questions need to be completed for the form submission to be successful.

*A copy of the completed form will be sent to your email ID given.

*A "Thank You" message will appear when your form is submitted successfully.

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