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Brookhaven School District Developmental Screeners
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* Indicates required question
Child’s Name
*
Your answer
Child’s Date of Birth
*
Your answer
Child’s Address
*
Your answer
Guardian’s Name
*
Your answer
Phone Number
*
Your answer
Are you concerned about any of the following for your child?
*
Developmental/Cognitive Skills
Language/Speech
Hearing or Vision
Other:
Required
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