Questionairre for Autism Study Name Email Address Child's First Name Child's Birth Date, Time, and City Parent #1 Birth Date, Time, and City Parent #2 Birth Date, Time, and City Is Parent #1 Mom or Dad? Is Parent #1 Mom or Dad? Mom Dad Is Parent #1 the Biological Parent? Is Parent #1 the Biological Parent? Yes No Child's Gender Is Parent #2 the Biological Parent? Is Parent #2 the Biological Parent? Yes No At what age was your child diagnosed with autism? Will you describe in the best way you can the level of functionality of your child at home and out in the world based on your own perception? Please include whether or not they attend school outside the home. What are your child's biggest challenges in life? Please describe in detail. What are your child's biggest strengths and talents? What are your child's interests? Does he/she apply their strengths and talents to these interests? How does your child handle being autistic in what is considered a neurotypical world? Are they sensitive to the opinions of others? Do they fit in at school? Do they embrace their uniqueness? Has your child experienced any trauma in their life? This would be anything that caused severe emotional distress such as a move, divorce, death of a loved one, bullying, changing schools, an incident with a friend, etc. Please state their age and date when it happened if possible. Please describe life challenges for Parent #1. Please describe Parent #1's strengths and talents. Please describe how your child has helped you grow, Parent #1. Please describe life challenges for Parent #2. Please describe Parent #2's strengths and talents. Please describe how your child has helped you grow, Parent #2. Privacy Notice This privacy notice discloses the privacy practices for AdrianeWilsonAstrology.com. This privacy notice applies solely to information collected by this website. It will notify you of the following: 1. What personally identifiable information is collected from you through the website, how it is used and with whom it may be shared. 2. What choices are available to you regarding the use of your data. 3. The security procedures in place to protect the misuse of your information. 4. How you can correct any inaccuracies in the information. Information Collection, Use, and Sharing We are the sole owners of the information collected on this site. We only have access to/collect information that you voluntarily give us via email or other direct contact from you. We will not sell or rent this information to anyone. We will use your information to respond to you, regarding the reason you contacted us. We will not share your information with any third party outside of our organization, other than as necessary to fulfill your request to be a part of this study. Unless you ask us not to, we may contact you via email in the future to tell you about information regarding the study you are participating in and further research being done by Adriane Wilson -Conscious Parent Coach and Evolutionary Astrologer. Your Access to and Control Over Information You may opt out of any future contacts from us at any time. You can do the following at any time by contacting us via the email address or phone number given on our website: * See what data we have about you, if any. * Change/correct any data we have about you. * Have us delete any data we have about you. * Express any concern you have about our use of your data. Security We take precautions to protect your information. When you submit sensitive information via the website, your information is protected both online and offline. If you feel that we are not abiding by this privacy policy, you should contact us immediately via telephone at 318-820-9789 or via adrianewilsonastrology@gmail.com. Privacy Notice This privacy notice discloses the privacy practices for AdrianeWilsonAstrology.com. This privacy notice applies solely to information collected by this website. It will notify you of the following: 1. What personally identifiable information is collected from you through the website, how it is used and with whom it may be shared. 2. What choices are available to you regarding the use of your data. 3. The security procedures in place to protect the misuse of your information. 4. How you can correct any inaccuracies in the information. Information Collection, Use, and Sharing We are the sole owners of the information collected on this site. We only have access to/collect information that you voluntarily give us via email or other direct contact from you. We will not sell or rent this information to anyone. We will use your information to respond to you, regarding the reason you contacted us. We will not share your information with any third party outside of our organization, other than as necessary to fulfill your request to be a part of this study. Unless you ask us not to, we may contact you via email in the future to tell you about information regarding the study you are participating in and further research being done by Adriane Wilson -Conscious Parent Coach and Evolutionary Astrologer. Your Access to and Control Over Information You may opt out of any future contacts from us at any time. You can do the following at any time by contacting us via the email address or phone number given on our website: * See what data we have about you, if any. * Change/correct any data we have about you. * Have us delete any data we have about you. * Express any concern you have about our use of your data. Security We take precautions to protect your information. When you submit sensitive information via the website, your information is protected both online and offline. If you feel that we are not abiding by this privacy policy, you should contact us immediately via telephone at 318-820-9789 or via adrianewilsonastrology@gmail.com. I have read and agree. 4 + 7 = Submit
