• ASCENSION AUTISM and GUT HEALTH CONSULTING

    ASCENSION AUTISM and GUT HEALTH CONSULTING

    data collection Marguerite O Reilly  

  • These questions can be modified based on the specific needs of the study and the population being studied.

     

  • 1. Has your child been diagnosed with autism or any other developmental disorder?

  • 2. Has your child been diagnosed with a mitochondrial disorder?
  • .3. Does your child have any dietary restrictions or preferences?

  • 4. Does your child take any medications or supplements?
  • 5. Has your child been exposed to any environmental toxins or pollutants?

  • 6. Has your child had any recent illnesses or infections? .

  • 7. Has anyone in your family been diagnosed with autism or a mitochondrial disorder?

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  • ACKNOWLEDGMENT

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  • ** This form must be fully completed and signed before informtion can be entered into our Referral Database. *

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