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Complete and submit the patient information by responding to the inquiry on this page.

Patient First & Last Names

Date of Birth

Age

Instructional Setting

Evatuation

Relationship to the Patient

Parent First & Last Names

Phone

Patient's Parents Custodial Status

Payment Method

Preferred Provider

Any Prior School or Psychological Evaluations

Yes No

Primary Concerns

Contact Preference

After receiving your email, our practice manager will respond with the next available appointment date.
You will receive a link to our INTAKEQ portal upon confirming the appointment.
To ensure the confidentiality and security of your information, our IntakeQ portal is HIPAA-compliant and privacy-protected.

Through the INTAKEQ portal, you can complete the Developmental History Intake, which provides information about your child’s development background.
Sign the necessary consent forms to allow us to proceed with the evaluation.
Upload Required Documents and relevant documents, including:
Past psychological evaluations
School evaluations (IEPs, METs, 504 plans)
Medical records (if applicable).

The importance of the forms

The developmental history and information provided through the INTAKEQ portal are critical to the evaluation process. The evaluation is based on this information, and any inaccuracies or omissions may affect the final report. Please be thorough and ensure that all relevant information is included.

Appointment confirmation deadline

Due to high demand, we require confirmation of your scheduled appointment within 48 hours.
If we do not receive your confirmation within this timeframe, your appointment may be moved to the next available date.

Waiting list

Our practice maintains a waiting list.
To ensure the earliest possible appointment, we strongly encourage you to complete the required paperwork as soon as possible. Should any cancellations occur, this will allow us to move your child’s appointment up.

Cancelation policy

We kindly ask that you notify us at least two weeks in advance if you need to cancel or reschedule your appointment. Given the time commitment required for each evaluation, it is difficult to replace a canceled session with another patient on short notice. Our practitioners reserve a full day to work with each patient, and last-minute cancellations affect our ability to serve other families who are waiting for available appointments.

Late arrivals

Arriving 30 minutes or more late for your scheduled appointment will result in rescheduling to the next available date. Late arrivals impact the evaluation process and may compromise the quality of the results, as it shortens the time needed for thorough testing. We appreciate your understanding and cooperation in helping us provide the best possible care for all our patients. If you anticipate being late, please contact our office as soon as possible. We will do our best to accommodate you, but please note that rescheduling will depend on the availability of our practitioners.

Providing prior psychological assessments/evaluations

Due to validity concerns, specific tests cannot be repeated within a 12-month timeframe. If your child has undergone testing within this period, we require access to the report to ensure we do not duplicate assessments. Failure to provide this information may invalidate testing. In such scenarios, you remain responsible for paying the entire evaluation balance. The ANC cannot be held responsible for incomplete information.

Schedule Now

The developmental history and information provided through the INTAKEQ portal are critical to the evaluation process. The evaluation is based on this information, and any inaccuracies or omissions may affect the final report. Please be thorough and ensure that all relevant information is included.

Due to high demand, we require confirmation of your scheduled appointment within 48 hours.
If we do not receive your confirmation within this timeframe, your appointment may be moved to the next available date.

Our practice maintains a waiting list.
To ensure the earliest possible appointment, we strongly encourage you to complete the required paperwork as soon as possible. Should any cancellations occur, this will allow us to move your child’s appointment up.

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Contact us

Schedule Now

The developmental history and information provided through the INTAKEQ portal are critical to the evaluation process. The evaluation is based on this information, and any inaccuracies or omissions may affect the final report. Please be thorough and ensure that all relevant information is included.

Due to high demand, we require confirmation of your scheduled appointment within 48 hours. If we do not receive your confirmation within this timeframe, your appointment may be moved to the next available date.

Our practice maintains a waiting list.To ensure the earliest possible appointment, we strongly encourage you to complete the required paperwork as soon as possible. Should any cancellations occur, this will allow us to move your child’s appointment up.

Menu

Contact us

Due to high demand, we require confirmation of your scheduled appointment within 48 hours.
If we do not receive your confirmation within this timeframe, your appointment may be moved to the next available date.

Our practice maintains a waiting list.
To ensure the earliest possible appointment, we strongly encourage you to complete the required paperwork as soon as possible. Should any cancellations occur, this will allow us to move your child’s appointment up.