Autism and other mental health care treatment contact Manushyaa Blossom Multispeciality Siddha Clinic

Autism Assessment Form (For Doctor’s use only)

Dear Parents

Manushyaa Blossom aims to provide the best treatment and services to your family. Please spare some of your valuable time to complete this form alongwith Manushyaa Blossom Doctors.

I. SOCIAL RELATIONSHIP AND RECIPROCITY

II. EMOTIONAL RESPONSIVENESS

III. SPEECH-LANGUAGE AND COMMUNICATION

IV. BEHAVIOR PATTERNS

V. SENSORY ASPECTS

VI. COGNITIVE COMPONENT

VII. OTHER HEALTH-RELATED OBSERVATIONS

The above informations submitted are true to best of my knowledge

Please Note:

*All questions need to be completed for the form submission to be successful.

*A copy of the completed form will be sent to your email ID given.

*A "Thank You" message will appear when your form is submitted successfully.