Literacy Screener
Not sure where to start? You're not alone—and that's exactly why we created this screener.At Dynamic Therapy Specialists, our licensed speech-language pathologists specialize in identifying and treating dyslexia. Simply answer a few quick questions, and our team will review your responses and reach out with personalized recommendations for next steps.
Child's Name
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First Name
Last Name
Child's Date of Birth
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-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Child's Current Grade
*
Person Completing This Form
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship to Child
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Where did you receive this free screeing flyer?
*
Please Select
DTS Email
DTS Website
DTS Staff Member
Provider
School
Redstick Mom
Other
Related Family History: Children with dyslexia and other related learning disorders often have a family history of reading or spelling challenges. Please respond whether a person in your child's family has a history of:
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Rows
Yes
No
Unsure
Difficulty learning to read
Diagnosis of dyslexia (or relevant)
Ongoing spelling difficulties
Diagnosed learning disability other than dyslexia
Avoiding reading or writing tasks
Difficulty learning a foreign language
Speech (articulation) disorder diagnosed
Rate your child compared to children the same age. Compared to other students of the same age, select the number to show how good your child is at...
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Rows
1 (Not Good)
2
3
4
5
6
7 (Very Good)
Understanding school vocabulary words
Using school vocabulary words when talking
Figuring out new words when reading
Spelling words correctly when writing
Understanding a story when listening
Telling a story that makes sense
Understanding a story when reading
Writing a story that makes sense
Is there anything else that you would like to share about your child that would best help us determine next steps?
Submit
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