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We believe in developing the full potential of kids through evidence-based practices. The focus is on meeting individual needs in a supportive, caring, and fun learning environment

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Child’s Name

Gender: MaleFemale

Date of birth

Your Name

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Which center would you like to visit?GorakhpurLucknowOnline

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Do you wish to provide additional information? YesNo

Medical Information

Diagnosis by(Name of Doctor and Clinic/Hospital):

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Secondary Diagnosis:

Date of Diagnosis:

Medical Conditions:

Parent’s Information

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Have you been refer from any one?YesNo

Referral Name

Every Child Is Unique
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Child’s Information

Medical Information

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Visit Us at Any of Our Centers

Lucknow Center 1

Every Child Is Unique Tell Us About Yours

Child’s Information

Medical Information

Parent’s Information

Every Child Is Unique
Tell Us About Yours