What language do you speak at home? (Check all that apply) *
Required
Does your child have a hearing loss? *
If yes, please describe the characteristics (unilateral or bilateral; mild, moderate, severe or profound):
Your answer
If yes, what hearing devices does your child use?
Do you have any concerns about your child's development? If so, please explain: *
Your answer
Is your child receiving any services (speech therapy, physical therapy, etc.)? If so, please explain.
Your answer
If you have another child (with or without hearing loss) that may be able to participate in the studies, please describe here. We will add him/her to the database too.
Your answer
How would you like to be contacted? Introduce here your phone number or email. We will just send you the opportunity to participate if your child qualifies. *