A community embracing students with dyslexia and language learning differences.

The Odyssey School Free Screening Information Form

All participants in the Free Screening Event must submit this form in advance of the scheduled screening date.
First and Last Name​​
Only children ages 8 and under are eligible for the free screening.​
Only children ages 8 and under are eligible for the free screening.​​












What are your concerns about your child?​
Does someone in your family have a history of reading, writing or speaking difficulties? If yes, please explain.​​
Does your child have any hearing difficulties? If yes, please explain.​​
Does your child have a history of repeated ear infections? If yes, please explain.​
Has your child been experiencing specific difficulties in school? If so, what kinds?​
Do you believe that your child has difficulties with sustaining attention to tasks? Please explain.​
Has your child demonstrated delays in learning to walk? ​
Has your child demonstrated delays in learning to talk? ​​
Has your child demonstrated delays in play behaviors?​
Do you believe your child’s development is delayed? If so, in what ways?​
Has your child ever been evaluated for a learning difference or for a development delay? If so, please explain.​

Struggle with Specific Skills

Simply select Yes to indicate that your child is struggling with the skill and No  if your child has never struggled with learning the skill.



Please provide an email address where we can send a link to your current form.

Email Address :
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