Editing previous response:

Please fix the highlighted areas below before submitting.

Snapshots Guide

Snapshots

First Name*

Answer required for "First Name"

Last Name*

Answer required for "Last Name"

Child's Name*

Answer required for "Child's Name"

Child's Date of Birth*

Answer required for "Child's Date of Birth"

Email *

Answer required for "Email "

Phone #

Number Required

City*

Answer required for "City"

County*

Answer required for "County"

Does your child have a suspected or identified hearing concern?*

Answer required for "Does your child have a suspected or identified hearing concern?"

Confirmation Email

Answer required for "Confirmation Email"