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Parent Survey
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* Indicates required question
What is your name?
*
Your answer
What is your email address?
*
Your answer
What is your child's name?
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Your answer
What is your child's date of birth?
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Your answer
Is your child male or female?
*
male
female
Other:
What grade is your child currently in? If summer, please list the grade your child will be in during the next school year.
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Your answer
How are you currently feeling about your child's experience in school? Please include information about current ability, current strengths and weaknesses, and any feelings your child has about school.
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Your answer
What interventions, if any, have you tried so far? Please include any services received from Dyslexia Treaters. Please also include dates of intervention services.
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Your answer
On a scale from 1 to 10, how familiar are you with dyslexia?
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Not familiar
1
2
3
4
5
6
7
8
9
10
Very familiar
On a scale from 1 to 10, how familiar are you with Orton-Gillingham intervention methods?
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Not familiar
1
2
3
4
5
6
7
8
9
10
Very familiar
Which dyslexia remediation programs are you familiar with? (Check all that apply)
*
Alphabetic Phonics
Take Flight
Multisensory Reading and Spelling
Reading Readiness
Barton Reading Program
Wilson Reading System
Lindamood-Bell
None of the above
Other:
Required
What are your goals for your child?
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Your answer
Please list at least three times you can have a zoom meeting with me in the next 2 weeks.
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Your answer
Is there any other information you would like me to know about you or your child?
*
Your answer
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