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Preschool Child Find Intake form 2023-2024
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* Indicates required question
Date intake completed
*
MM
/
DD
/
YYYY
What are your area of concerns?
*
Communication
Adaptive Skills (Things that they can do for themselves- wash and dry hands, use the toilet, dress and undress, etc.)
Behavior
Social/Emotional
Fine Motor/Gross Motor
What are your developmental concerns for your child? (please be as specific as possible)
*
Your answer
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