top of page

Home
Book Online
Program List
Notifications
My Subscriptions
Resources

Book Now

No form ID specified in URL

Parent Name*

Parent address

Country/Region*

Address*

City*

Zip / Postal code*

Phone number*

Email*

Child Information

Child's full name*

Child's birthday*

Month

Day

Year

Has your child had an educational diagnostic evaluation done before?*

Yes

No

Who they live with*

Grade*

School name*

School type*

Public school

Private school

Charter school

Homeschool

Concerns

Health and Wellness

Any illnesses or medical conditions

Pregnancy details

Developmental Milestones

Physical and Motor Development

Does your child wear glasses?*

Yes

No

Does your child use a hearing aid?*

Yes

No

Additional hearing and vision information

Additional Information

Current services or therapies

Speech therapy

Occupational therapy

Physical therapy

Behavioral therapy

Tutoring

Conseling

None

Other services

Family history of learning differences

Child's strengths and interests

How did you hear about us?*

School referral

Doctor referral

Friend or family

Online search

Social media

Other source

I consent to the collection and use of this information for evaluation purposes and understand that all information will be kept confidential.

Days available to talk

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Times available to talk

Morning (8:00 AM - 12:00 PM)

Afternoon (12:00 PM - 5:00PM)

Evening (5:00 PM - 8:00 PM)

Late evening (8:00 PM - 10PM)

Professional Diagnostics for Bilingual Learners

information@insighteducationaldiagnostics.org

214-531-3398

Flexible payment plans available. Aceptamos la mayoría de las tarjetas.

bottom of page