Autism Quiz

Complete this 1-minute Autism Quiz

Find out of your child is a candidate for Autism Treatment with MeRT, Magnetic Resonance Therapy. For additional information on our treatment for Autism, click here.

Autism Quiz

These questions are designed to help determine if your child may benefit from Magnetic Resonance Therapy (MeRT).

What severity of autism does your child have?
- Mild spectrum disorder
- Moderate autism
- Severe autism
At what age was your child diagnosed as having autism?
How old is your child now?
Does your child have any other developmental delays?
- Gross motor
- Fine motor
- Adaptive skills
- Cognitive delays
- Perceptual impairment
- Social delays
- None of these
Check all that apply.
Does your child have behavioral issues?
- Yes, severe
- Yes, moderate
- Yes, mild
- No
Does your child speak?
- My child does not speak
- My child has severe speech delays
- My child has moderate speech delays
- My child has mild speech delays
- My child has no speech delays
Is your child able to follow directions?
- Can follow one step instructions (Get the ball, please)
- Can follow multiple step directions (Go to your room, get your shoes, and bring them here, please)
- Has trouble following any instructions
Does your child respond to their name with eye contact?
- Yes
- No
- Sometimes
Does your child interact with his / her peers?
- Yes
- No
- Sometimes
Can your child do simple daily living skills independently? (eating, dressing, bathing)
- Yes
- No
- My child is not of age yet
How would you like us to respond to you?
Your Name?*
Phone Number*
I consent to receive text messages from this business*
- Yes
- No
Email Address*
Best time to reach you
How did you find us?*
- Google Search
- The Doctors tv show
- Dr. Oz
- Facebook
- Radio or TV
- Referral

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Our New Patient Coordinator is happy to talk with you, explain the our treatment protocols and fees and answer any questions you may have.

Contact our New Patient Coordinator for a Consultation

(949) 418-1108

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Contact Us

New Patients – 949-418-1108

Existing Patients – (949)851-3086

Fax – (949) 398-8072

Address: 1601 Dove Street, Suite 275
Newport Beach, CA 92660

Hours

Monday to Friday, 9AM to 5PM

Autism Quiz

How would you like us to respond to you?