Our district doesn't have pre K, but in the last few years they have revamped curriculum and taken our Kindergarten to full day, and it is called the new first grade. Even though she is intelligent she will struggle with it if she can't talk (not to mention social issues due to never being around kids her own age). The teachers do make the recommendations for speech, but the parent has to sign releases and I don't know what would be done if they would choose not to. I know when it was suggested my step nephew get some testing for learning disabilities, my sis in law said no and the school did not pursue it. As far as the dr, I know I have a pediatrician who is on top of things and listens to concerns and watches for appropriate developmental milestones. Unfortunately, they go to the GP she works for for just basic well visits (shots, height, weight). And yes, I have suggested my pediatrician, simply for the fact of how close he is to our house but she said they were fine because the kids only go for their shots so she was ok. It saddens me that something so simple to address is just being waved off but to say anything more is just going to be talking to a wall, so I will sit back and hope they have an epiphany and do something.