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CURABILITY CHECK
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Home
About Us
About Autism Homeo Treatiment
About Dr Krunal Kosada
Disease
Autism
ADHD
Genetic Disorder
Angelman’s Syndrome
Down Syndrome
RETT Syndrome
Neurological Disorder
Cerebral Palsy
Convulsion
Global Development Delay (GDD)
Speech Disturbance
Learning Disability (Dyslexia)
Gallery
Dr. Krunal Kosada
Samvedna Clinic
Testimonials
Video Testimonials
Blog
Contact Us
Online Consulting
Home
About Us
About Autism Homeo Treatiment
About Dr Krunal Kosada
Disease
Autism
ADHD
Genetic Disorder
Angelman’s Syndrome
Down Syndrome
RETT Syndrome
Neurological Disorder
Cerebral Palsy
Convulsion
Global Development Delay (GDD)
Speech Disturbance
Learning Disability (Dyslexia)
Gallery
Dr. Krunal Kosada
Samvedna Clinic
Testimonials
Video Testimonials
Blog
Contact Us
Online Consulting
Book a Treatment Package
Patient Name
Father's Name
Mobile
Alternate Phone
Address
City
State
Zip
Email
Remarks/any specific points you would like to mention
What is the age of your child?
Any reports/attachment you would like to submit?
Only PDF, PNG, JPG, and JPEG file types are allowed.
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Curability Check
Step 1 of 7 - General Information
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Name
*
Phone Number
*
Email
*
Select Assessment for
*
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Autism
ADHD (Hyperactivity)
Learning Disorder
Genetic Disorder
Neurological Disorder
1. What is the age of patient today
a. 2-3year
b. 3-5year
c. 5-7year
d. 7 year or above
2. What about his eye contact?
a. No eye contact
b. Poor eye contact
c. Only to familiar persons
d. Has eye contact
3. What about his speech development?
a. Speech absent
b. Few words
c. Regressed
d. Can speak normally
4. Any sensory issues (visual, hearing, tactile sensory) that your child is facing in daily life?
a. Has many sensory issues
b. 1-2 sensory issues
c. Rarely happens
d. Has no sensory issues
5. Is your child hyperactive or has behavioral tantrums like hitting, kicking, destructive activities, etc?
a. Yes, very often
b. Sometimes
c. Rarely
d. No
6. Any associated complaint (e.g., ADHD, learning disability, convulsion, nystagmus, digestive troubles, low immunity, sleep disturbance) with autism?
a. Yes
b. No
7. Has your child or mother suffered from any complications or disease(e.g. Late birth cry, Low body weight, oligohydroamnios, stress during pregnancy, history of abortion) during pregnancy or after delivery?
a. Yes
b. No
1. What is the age of patient today?
a. 2-3year
b. 3-5year
c. 5-7year
d. 7 year or above
2. What is approximate sitting tolerance time of your child?
a. Always on move
b. 5min
c. 10min
d. 15min
3. Is your child having tendency to break and destruct things?
a. Yes
b. No
4. Is your child having attention seeking behavior when you talk with somebody else?
a. Don’t allow to talk
b. Sometimes
c. rarely
d. No
5. Do any complaints come from school for your child’s behavior with other kids?
a. School denied to give admission
b. Always
c. Sometimes
d. Never
6. Any associated complaint (e.g., learning disability, convulsion, nystagmus, digestive troubles, low immunity, sleep disturbance) with ADHD?
a. Yes
b. No
7. Has the child or mother suffered from any complications or disease(e.g. Late birth cry, Low body weight, oligohydroamnios, stress during pregnancy, history of abortion) during pregnancy or after delivery?
a. Yes
b. No
1. What is age of your child?
a. 2-3year
b. 3-5year
c. 5-7year
d. 7 year or above
2. What is the minimum time limit your child can concentrate at study?
a. Always on move
b. 5min
c. 10min
d. More than 10min
3. Is your child making any excuses while doing his homework like want to drink water, going toilet, getting hungry?
a. Often
b. Sometimes
c. Rarely
d. No
4. Is your child having any one of it - spelling mistakes, bad handwriting, calculation mistakes?
a. Yes
b. No
5. Did you found your child having problem while understanding or getting confused? Is your child facing problem in his academics?
a. Yes
b. No
6. Is your child facing problems with gross motor skill or fine motor skill ?
a. Yes
b. No
7. Has the child or mother suffered from any complications or disease(e.g. Late birth cry, Low body weight, oligohydroamnios, stress during pregnancy, history of abortion) during pregnancy or after delivery?
a. Yes
b. No
1. What is age of your child?
a. 2-3year
b. 3-5year
c. 5-7year
d. 7 year or above
2. Are there any complications during birth or pregnancy?
a. Yes
b. No
3. Does your child’s facial features look different as compared to other children?
a. Yes
b. No
4. Are your child’s developmental milestones (e.g. teething/crawling/ walking/ speech) delayed or is a slow learner?
a. Yes
b. No
5. Is your child doing any abnormal behavior in his daily routine?
a. Yes
b. No
6. Any associated complaint (e.g., learning disability, convulsion, nystagmus, digestive troubles, low immunity, sleep disturbance) with genetic disorder?
a. Yes
b. No
7. Has the child or mother suffered from any complications or disease(e.g. Late birth cry, Low body weight, oligohydroamnios, stress during pregnancy, history of abortion) during pregnancy or after delivery?
a. Yes
b. No
1. What is age of your child?
a. 2-3year
b. 3-5year
c. 5-7year
d. 7 year or above
2. Has the child or mother suffered from any complications or disease(e.g. Late birth cry, Low body weight, oligohydroamnios, stress during pregnancy, history of abortion) during pregnancy or after delivery?
a. Yes
b. No
3. Are your child’s developmental milestones (e.g. teething/crawling/ walking/ speech) delayed or is a slow learner?
a. Yes
b. No
4. Is your child facing problems with gross motor skill or fine motor skill or muscular disability?
a. Yes
b. No
5. Is your child having any medical history of seizure/convulsion?
a. Yes
b. No
6. Is your child suffering from any difficulties in comprehensive skills?
a. Yes
b. No
7. Any abnormalities in brain MRI/EEG reports?
a. Yes
b. No
Any other information that you would like to provide
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