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Yellowbird Learning Waitlist and Initial Questionnaire

I am currently booking dyslexia assessments beginning January of 2024. If you are interested in joining the waitlist, please answer the following questions as best as you can.

 
Once I have received the form, I will be in contact within 48 hours with the next steps.

Click the button below to start.

Start

Question 1 of 25

Parent Email:

Welcome!

Congratulations on pursuing a dyslexia assessment for your child! That is an important first step in getting your child the help they need.
I am a certified educational therapist, national board certified teacher, and certified structured literacy dyslexia interventionist (CSLD-I) who specializes in dyslexia assessment, remediation, and advocacy.
I am deeply passionate about identifying dyslexia at an early age and ensuring that children receive the appropriate interventions they need so they can gain the skills they need to thrive.

How the Process Works

  1. Complete this initial form to provide information about your child. I will use your responses to determine if your child is a good fit for dyslexia assessment.
  2. If your child is a good candidate for the Tests of Dyslexia (TOD), you will complete the intake forms I provide and schedule the assessment on my calendar.
  3. Attend the assessment. This can be done remotely on Zoom (Pacific Standard Time) or in person in Los Angeles. The assessment typically takes between 60-90 minutes.
  4. Schedule and attend a 1-hour follow-up to discuss the findings of the assessment and to receive a detailed report and intervention plan. This typically takes place around 2 weeks after the assessment.
*Reminder, I am booking in January of 2024, so right now, you are just joining the waitlist. Please still complete the information below. I will share the intake forms closer to January.

About the Assessment

I use the Tests of Dyslexia (TOD), which is the first comprehensive dyslexia assessment on the market.

 
The TOD has three batteries: the TOD-Screener, the TOD-Early, designed for the early identification of students in Grades K–2 (5 years-9 years, 3 months); and the TOD-Comprehensive, designed for students from Grade 1 to adulthood (6 years–89 years).  

The TOD assessment includes:  

  • indexes designed to indicate the risk and probability of dyslexia; 
  • composites and tests that measure reading skills (untimed and timed), spelling, specific linguistic risk factors (phonological awareness, orthographic processing, rapid automatized naming, and working memory), and vocabulary and reasoning abilities; 
  • self, parent, and teacher rating scales designed to capture qualitative indicators of dyslexia, such as a family history of reading problems and early difficulties with speech and language (To ensure the most comprehensive assessment for your child's dyslexia, your active participation is essential. We kindly request that you allocate time to complete the parent rating scales thoroughly. Additionally, we ask for your cooperation in sharing the rating scale with your child's teacher and facilitating the return of the completed form.)
  • Dyslexia interventions and recommendations report to provide the school to develop IEPs and targeted intervention plans to address specific skill weaknesses. 

Question 5 of 25

Are you willing to commit to completing the parent rating scale and getting the rating scale from your child's teacher?

A

Yes

B

No

If this sounds like what you're looking for, please continue to provide information about your child (student).

Please answer the following questions as best as you can:

Question 7 of 25

Parent First & Last Name

Question 8 of 25

Child's First & Last Name

Question 9 of 25

Child's (Student's) School

Question 10 of 25

Child's (Student's) Date of Birth

Question 11 of 25

What is your child's (student's) current grade level? (If summer, what is their most recently completed grade?)

A

Pre-K

B

Kindergarten

C

1st

D

2nd

E

3rd

F

4th

G

5th

H

6th

I

Other

Question 12 of 25

What prompted your interest in seeking a dyslexia assessment for your child?

Question 13 of 25

Please describe any challenges you've noticed in your child's reading, writing, or overall learning.

Question 14 of 25

Have you noticed any emotional or confidence-related changes in your child regarding reading or learning?

Question 15 of 25

Are there any other relevant details you'd like to share about your child's learning experience or challenges?

Question 16 of 25

Has your child been diagnosed with any of the following?

(Select all that apply)
A

Dyslexia (Specific Reading Disability)

B

Dysgraphia (Specific Writing Disability)

C

Dyscalculia (Specific Mathematics Disability)

D

Attention Deficit/Hyperactivity Disorder (Inattentive, Hyperactive, or Combined)

E

Speech/Language Deficits

F

Hearing Deficits

G

Autism Spectrum Disorder

H

No Known Learning Disabilities

I

Other

Question 17 of 25

If your child has not been formally diagnosed with any of the above learning disabilities, do you suspect that they may have one? If so, please explain.

Question 18 of 25

Does your child have any behavioral or attention difficulties at school?

A

Yes

B

No

Question 19 of 25

Has your child been tested for an Individualized Education Program (IEP) in the past?

A

Yes

B

No

Question 20 of 25

Is your child currently receiving school-based support through:

A

An Individualized Education Program (IEP)

B

A 504 Plan

C

No

D

Other

Question 21 of 25

What other academic supports is your child currently receiving or have they received in the past (e.g., tutoring, school-based supports, etc.)?

Scheduling

Dyslexia assessments take place exclusively on weekends. Parent follow-up meetings occur during the week in the late afternoons or early evenings (Pacific Standard Time).

Question 23 of 25

Are you able to commit to promptly scheduling a dyslexia assessment and a follow-up meeting? 

A

Yes

B

No

Question 24 of 25

Assessment Location - I'm looking for:

A

Online assessment (conducted via Zoom)

B

In-person assessment (exact Los Angeles location provided upon confirmation)

C

Either (First Available)

Thank You!

I appreciate you taking the time to fill out this questionnaire. I look forward to being in touch within 48 hours.

Confirm and Submit