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General Reason for Referral

What prompted you to seek psychological testing at this time? (Provide more information for the practice - topics you wish to discuss, any assistance required, etc)

Are there specific concerns or questions you hope the assessment will address?

Previous Evaluations and Interventions

Have you (or your child) ever had any testing done before, like for learning, medical, or mental health reasons? If so, when was it and what did you find out?

Have you (or your child) tried any help or support before, like therapy, tutoring, or medication? If yes, can you tell me a bit about that?

Goals and Expectations

What do you hope to learn or achieve from this interview or assessment?

Is there anything specific you’re worried about, like ADHD, learning issues, autism, or mood problems? Has anyone else ever brought up these kinds of concerns?

When is the report required?

Are you (or your child) able to read, and are they capable of completing a questionnaire prior to their appointment?

Do you (or your child) have a trusted person or family member who can complete questionnaires or provide collateral developmental history?