Family Profile (optional)

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Special Needs in Children
Expand categories and select any special needs that you are open to. (Pick at least three.)

1. Blood Conditions
   1. Blood Disorder
   2. Hemophilia
   3. Hepatitis B Positive
   4. Hepatitis C
   5. HIV Positive
   6. Lead Exposure
   7. Lymphedema
   8. Sickle Cell Anemia
   9. Thalassemia
2. Chromosome Disorders
   1. Cystic Fibrosis
   2. Down Syndrome
   3. Genetic Syndrome
   4. PKU
   5. Teratoma
   6. Turner Syndrome
3. Congenital Heart Defects
   1. Atrial Septal Defect (ASD)
   2. Heart Defect
   3. Tetralogy of Fallot
4. Craniofacial Conditions
   1. Apert Syndrome
   2. Cleft lip or palate
   3. Hemifacial Microsomia
5. Developmental Needs
   1. Apraxia of Speech and Muteness
   2. Autism Spectrum Disorders (ASD's)
   3. Cognitive Delays
   4. Failure to Thrive
   5. Fetal Alcohol Syndrome
   6. Growth Delay
   7. Motor Delays
   8. Premature Birth
   9. Psychomotor Development Retardation (PDR)
   10. Speech Delay
6. Digestive System Conditions
   1. Hernia
   2. Megacolon
7. Hearing
   1. Deaf
   2. Hearing Impairment
   3. Microtia and Atresia
8. Neurological Conditions
   1. Cerebral Palsy
   2. Dyskinesia
   3. Epilepsy
   4. Hydrocephalus
   5. Microcephaly
   6. Seizure Disorder/ Epilepsy
9. Orthopedic Conditions
   1. Amniotic Band Syndrome / Missing Limbs
   2. Arthrogryposis
   3. Brachial Plexus Injury
   4. Club foot
   5. Digit Difference
   6. Dwarfism
   7. Flexion Deformity
   8. Funnel Chest / Pigeon Breast
   9. Limb Differences
   10. Osteogenesis Imperfecta
   11. Radial Club
   12. Rickets
   13. Scoliosis
   14. Spina Bifida
   15. Torticollis
   16. Wheelchair Dependent
   17. Wheelchair Dependent
10. Other Considerations
    1. 9 Years Plus
    2. AGEING OUT
    3. Attachment Issues
    4. Second Placement
    5. Trauma
11. Skin Conditions
    1. Albinism
    2. Burns
    3. Congenital Blue Nevus
    4. Congenital Nevi
    5. Eczema
    6. Epidermolysis Bullosa (EB)
    7. Hemangioma
    8. Ichthyosis
    9. Port Wine Stains
12. Urogenital Conditions
    1. Ambiguous Genitalia
    2. Anal Atresia / Imperforate Anus
    3. Hypospadias
    4. Incontinence
    5. Kidney Issues
13. Vision
    1. Blind
    2. Cataracts
    3. Lazy Eye / Amyblyopia
    4. Missing Eye
    5. Nystagmus
    6. Ptosis
    7. Strabismus
    8. Visual Impairment