Parent/Family Update Form

[By completing the form and clicking "submit" below, I am indicating that I am willing to continue being part of the CMV support group network. I understand that my name, address and phone number will be made available to other families of CMV children who are seeking advice and support.]

Update my family's profile

Child's Information

Sex: Male Female

Parents' Information

Bilingual Spanish? Yes No

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Send Support Network list via: CD sent by postal mail PDF sent by E-mail

Please provide a brief description of your child's abilities/disabilities. For example: "At age 3 years, our child is functioning at the 15-month level, has microcephaly, and has some hearing loss, but he is very happy and is just beginning to walk."

Are you willing to have this information shared with other families?
Yes No

Cochlear Implant? Yes No

Please list other resources you have found helpful. For example: magazines/newsletters, toys, support groups, appliances, organizations, etc. Please provide as much info as you can and is appropriate (i.e. Resource type, Name of resource, contact address, contact phone, contact fax, contact e-mail, etc.)