1. Do you confuse the addition and multiplication signs or the subtraction and division signs?    
Yes  No  
2. Do you tend to run into things even though you try to avoid them?    
Yes  No  
3. Do you confuse your right and left?    
Yes  No  
4. Do you occasionally write or print backward or reverse your letters?    
Yes  No  
5. Do you read or talk with any degree of hesitation?    
Yes  No  
6. Do you have poor motor coordination?    
Yes  No  
7. Do you have short span memory retention?    
Yes  No  
8. Do directional signs confuse you?    
Yes  No  
9. Do you have to ask people to repeat conversations because you're not sure what they said?    
Yes  No  
10. Do you get lost when trying to follow directions to a location?    
Yes  No  
11. Do you lose or skip lines while reading?    
Yes  No  
12. Do you lose the sense of what you are reading?    
Yes  No  
13. Do you have difficulty with reading, writing and mathematics?    
Yes  No  
14. Do you have an inability to relate to people in groups or to understand the conversation?    
Yes  No  
15. Do you have poor or non-existent sense of direction?    
Yes  No  
16. Do you have little or no concept of time?    
Yes  No  
 17. Do you have an inability to concentrate, even when involved in a particular activity, such as a game?    
Yes  No  
18. Do you stutter, have hesitant speech, and poor word recall?    
Yes  No  
19. Do you have an inability to remember names?    
Yes  No  
20. Do you have sharp emotional or mood swings?    
Yes  No  

If you would like Dr. Turner to call you to discuss your child's condition please fill in the following. We will respond within 24 hours during weekdays.    

Name:    
Email address:     
Phone No: