Information about the child.

For individual parents, PEDS costs $19.95 each time you take it. You can choose to pay using a credit or bank card or PayPal after test completion or later.

Please fill in as many of the items as you can (and all that are marked with a red asterisk) We won't give this information to anyone else and it helps us to improve the accuracy of our tests.

First Name *

Middle Name

Last Name *

Gender

Address

The address is in

City

State

Zip or Postal Code

Country

What language do you speak at home?

Your relation with child

Child's race

Is this child enrolled in any programs now? Check all that apply:
Daycare Headstart Preschool Grade School Special education Speech/language therapy Physical/occupational therapy

School Name:

If your child been tested before, please describe the results:

Date of Birth *

Child's age (computed)

Was this child born early *
Yes No

How many weeks?

PEDS TEST