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The Therapy Path 7 Balsam Street South 2nd floor Timmins Ontario P4N 2C7 Phone 705 267-2266 Fax 705 267-2270 www. Therapypath. com First Step to Literacy Questionnaire Child s Name D. O. Birth Age Parents/Guardian Names Current date Address City Postal Code Phone Past Medical and Surgical History Hearing Year tested Results Vision Year tested Results Problems with Diet Prior injury No Yes Sleep Allergies Prior or current medical condition Educational History Attendance record absent days...
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