Although it is lengthy, it is important to obtain a clear and accurate developmental history of your child in order to understand their learning ability, current and past functioning, and behavior. Please complete this form to the best of your ability. If you feel uncomfortable completing any section, feel free to place “N/A” and discuss further with your examiner. Information will remain confidential and will not be shared with third parties without your authorization except in cases when disclosure is mandated by law (please see HIPPA policy for more details).