(i) Name of the child.
(ii) Age of the child.
(iii) Sex of the child.
(iv) Address.
(v) Place of birth.
(vi) Age of parents.
(vii) Marital status.
(viii) Family history.
(ix) Date of birth.
(x) Names of parents/ guardians.
(xi) Occupation of parents.
(xii) Pre-natal history.
(xiii) Birth history of the child.
(xiv) Development milestones.
(xv) Age at onset of the problem.
(xvi) Medical history of the child.
(xvii) Educational history/ school/ grade/ child's educational progress/ how was the child doing pre-academically.
(xviii) Special services that the child is receiving.
(xix) How does the child interact with others/ shy/ aggressive/ co-operative/ unco-operative.
(xx) Name and signature of the parent/ guardian completing the form.
maurice.mutuku answered the question on August 24, 2017 at 07:34
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