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Get and Sign , Suite 200 Rockville, MD 20852 Phone 301 593 6554 Fax 301 255 0461  Form

Get and Sign , Suite 200 Rockville, MD 20852 Phone 301 593 6554 Fax 301 255 0461 Form

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Poor handwriting Clumsiness Poor memory Poor self-esteem Short attention span Sleep problems nightmares Stealing lying Destructiveness Fighting Frequent mood changes Irritability Slurred speech Facial or other tics Alcohol/substance abuse Describe any checked above 3 Page SCHOOL HISTORY Rate your child s school experience related to ACADEMIC LEARNING Nursery School Good Average Poor Elementary School Middle School Current Grade To the best of your knowledge at what grade level...
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