Questionnaire
If many of the symptoms apply to you or your child, you he/she may have a listening dysfunction. Feel free to use this form to select any categories that apply to you and then fill in your contact details and submit it, in order to find out the best suitable way to help you.
[contact-form id:very-special][contact-field label=’History of ear infections (also having tubes placed) during childhood’ type=’checkbox’/][contact-field label=’Headacges during times of learning%26#x002c; or paying attention’ type=’checkbox’/][contact-field label=’Difficuties with stuttering’ type=’checkbox’/][contact-field label=’Difficulties with articulation’ type=’checkbox’/][contact-field label=’Difficulty saying words of several syllables’ type=’checkbox’/][contact-field label=’Confusion of similar sounding words’ type=’checkbox’/][contact-field label=’Sound%26#x002c; letter or number reversals’ type=’checkbox’/][contact-field label=’Delayed language / weak vocabulary’ type=’checkbox’/][contact-field label=’Broken or hesitant speech’ type=’checkbox’/][contact-field label=’Weak, flat or monotone voice’ type=’checkbox’/][contact-field label=’Over-sensitivity to sounds’ type=’checkbox’/][contact-field label=’Poor memory’ type=’checkbox’/][contact-field label=’Frequent daydreaming’ type=’checkbox’/][contact-field label=’Short attention span/easily distracted’ type=’checkbox’/][contact-field label=’Misinterpreting simple requests’ type=’checkbox’/][contact-field label=’Need directions repeated or simplified’ type=’checkbox’/][contact-field label=’Hyperactivity, restless during attentive work’ type=’checkbox’/][contact-field label=’Lack of motivation to complete works’ type=’checkbox’/][contact-field label=’Forget to give or hand in sloppy assignments’ type=’checkbox’/][contact-field label=’Poor, slumped posture’ type=’checkbox’/][contact-field label=’Awkward co-ordinations/clumsy’ type=’checkbox’/][contact-field label=’Sensitivity to movement (boat, amusement park rides)’ type=’checkbox’/][contact-field label=’Left/right confusion’ type=’checkbox’/][contact-field label=’Dislike in participation in sports’ type=’checkbox’/][contact-field label=’Constant movement’ type=’checkbox’/][contact-field label=’Low energy’ type=’checkbox’/][contact-field label=’Lack of motivation’ type=’checkbox’/][contact-field label=’Low frustration tolerance’ type=’checkbox’/][contact-field label=’Low self-confidence/shyness’ type=’checkbox’/][contact-field label=’Immaturity’ type=’checkbox’/][contact-field label=’Increasing difficulty with memory as you age’ type=’checkbox’/][contact-field label=’Increasing balance difficulty as you age’ type=’checkbox’/][contact-field label=’Emotional difficulties and stress’ type=’checkbox’/][contact-field label=’Name’ type=’name’ required=’1’/][contact-field label=’Email’ type=’email’ required=’1’/][/contact-form]