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General Details

School History

When did you leave education?
Prior to GCSEs / O Levels
After GCSEs / O Levels
After A Levels
After Diploma
After Degree
Other

For the following questions please rate how difficult you find these tasks: (0 for easy, 5 for very hard)

*How well you understand the text that you have read

Did you receive SEN or extra help at school?
Have you ever been diagnosed or assessed for the following?

Symptoms

Do you experience any of the following when reading or writing:
Do you avoid reading or writing
Yes
No
Do you feel your issues with reading / close work have impacted your life?
Yes
No

Medical / Mental Health

*This info is only shared with our Clinical staff members

Childhood and Development

Birth type
Natural
Natural w/ Forceps
Natural w/ Vonteusse
Unknown
Were you:
Premature
On time
Late to deliver
To your knowledge did you meet your developmental milestones?
Yes
No
Unknown
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