Help us with your story, to keep a sound of hope to others who may benefit from the Tomatis Method.

Your story will change the lives others.

Please send us an e-mail a photo of your child Tomatis Center of Puerto Rico welcomes your participation and will give you a discount of $50.00 when we publish the story.

Child's Name __________________________________                           Phase_______

Permission to publish: □ my real name and my Child □ fictitious name for myself and my child

□ Permission to publish the photo of my child

Briefly describe how you heard about our treatment: ________________________________________________

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 Briefly describe why the child enrolled in our treatment: ______________________________________________

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Describe your child (behavior) before treatment: ___________________________________________________

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Describe your experience during the treatment process and has assisted in the development of  the children: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Other comments ___________________________________________________________________

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* With my signature I authorize that this story is edited and published in various media.

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Name                                                               Signature                                              Date