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First Name
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Last Name
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Phone
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e.g. 555-555-5555
Email
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Did you take Tylenol and/or generic brand Acetaminophen during your pregnancy?
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How many total days did you take Tylenol/Acetaminophen during your pregnancy?
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Less than 7 days
Between 1-4 weeks
More than a month
Has your child been diagnosed with Autism?
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Yes
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In what year was your child diagnosed with Autism?
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When would be a good time to call you?
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12pm-2pm
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Anytime
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