Testing services are only offered at our Colorado Location at this time.

A member of our team will review your information in the order it was received. They will either contact you for more information or automatically add you to our wait list.

First Name *

Preferred/Chosen Name

Last Name *

Pronouns

He/Him

She/Her

They/Them

Other

Date of birth *

Email *

Phone *

I am filling this out for an individual that is not myself (ex. my child) *

Yes

Parent/Legal Guardian Full Name

Parent/Legal Guardian Phone Number

Are you located in Colorado? *

What testing services are you interested in? *

Psychological Assessment - Autism Spectrum Disorder (ASD)

Psychological Assessment - ADHD

Psychological Assessment - Learning Disorders

Psychological Assessment - Personality Disorders

Psychological Assessment - Mood Disorders (Bipolar & Depression)

Psychological Assessment - Obsessive Compulsive Disorder (OCD)

Psychological Assessment - Post-Traumatic Stress Disorder (PTSD)

Psychological Assessment - Intellectual Disability (ID)

*Please note: We DO NOT provide FULL NEUROPSYCHOLOGICAL EVALUATION services* --- Colorado Medicaid only covers services for Autism Spectrum Disorder and Intellectual Disability Evaluations. If you have Medicaid and are seeking a different type of evaluation, prior authorization must be obtained.

Have you undergone a Psychological Assessment in the last two years? *

Do you currently use substances (not including prescription medication)? *

If using substances, please describe type and frequency.

Substances can impact cognitive performance so in order to get the clearest picture for your evaluation we would ask that you abstain for 3 weeks prior to your testing date

Are you wanting to use this evaluation for a legal case or disability? *

We are not a forensic evaluation site. Therefore we do not provide assessments to determine disability, custody or any other legal or criminal case

Primary Insurance for Services (Testing) *

Insurance or Medicaid ID Number (Required for Medicaid)

CO Medicaid will only cover testing when an individual is tested for autism spectrum disorder (ASD) or intellectual disability (ID). By law, we cannot take out of pocket payment from Medicaid clients.

Upload Front of Insurance Card *

Upload Back of Insurance Card *

Location Preference *

Please note: Testing will require some in-person availability at one of our Colorado office locations. See the "Locations" tab for exact addresses. At this moment, the majority of clinicians are based out of our Denver office.