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Please see our “FAQ’s” page for questions related to the practice, the evaluation procedures, our policies, and additional information.
If you are prepared to schedule an appointment, please complete and submitt the inquiry below.
Our Practice Administrator will contact you to be placed on our calendar and provide you with the Developmental History document and Consent Forms to be completed before the appointment day.

STEP 1: Complete Patient & Parent Information

STEP 2: Review HIPAA Document & Sign Confidentiality & Practice Policy Documents

STEP 3: Complete & Return Developmental History Documents

STEP 4: Send Prior Evaluations

Patient Information

First Name

Last Name

Date of Birth

Instructional Setting

Parent/Guardian Name

First Name

Last Name

Email

Phone

Custodial Status

Evaluation Type

Payment Method

Preferred Provider

Any Prior School or Psychological Evaluations

Yes No

Primary Concerns

Contact Preference