Can Dry Kid Academy Help?

How old is your child? *
Does your child wet only during sleep? *	Yes No
How long has the wetting been occuring? *
How often does wetting occur? *
What have you already tried? *
Is your child a deep sleeper? *	Yes No
Is your child currently taking any medication for any condition? *	Yes No
If you answered yes to the last question, what medication or condition?
Is there a family history of bedwetting? *	Yes No
Child's first name:
Parent/Guardian Name: *
Parent/Guardian Email: *
Mailing Address (optional):
Telephone (optional):
In most cases we can come to your home to interview you and your child and start the process. Would you like information about that? *	Yes No
We are piloting live web-based programs. Would you be interested in participating in something like that? *	Yes No
Dry Kid Academy has a sliding scale fee based on need. Would you like more information about this? *	Yes No
How would you like us to contact you?
When is there a best time?
Is there anything else you would like to add? *