Child Screening Questionnaire

The child screening questionnaire consists of 5 parts as follows:

  • General Information
  • Neurology
  • Schooling
  • Nutrition
  • Madaule Auditory Screening

Please complete the questionnaire and submit it for evaluation; alternatively print the questionnaire and mail it to the following address:

Sue Hyland
110 West Town Lane
Bristol BS4 5DT

I charge £50.00 for the evaluation of the questionnaire which can be payed into my PayPal account. Should you continue with further treatment this £50.00 is set against further fees.

The Questionnaire is in PDF format. You will need Adobe Reader to view and print this. If you do not have a copy of Adobe Reader you can down load one from:

Down Load Questionnaire

Note: You will need to save the down loaded PDF form onto your computer before opening it in Adobe Reader. I cannot guarantee that all the facilities will work if you complete the form in a browser as many do not fully support PDF functionality.

Please note that part of the screening questionnaire was externally validated for INPP. A score of 7 or more on specific questions (asterisked) confirms a 98% probability of retention of Primitive Reflexes. Retention of Primitive Reflexes being the primary cause of neuro-developmental delay.