Request an Evaluation

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If you are an existing client, please use the Client Portal instead.

Taking the first step does not require having everything figured out. This brief form helps me understand your concerns and determine appropriate next steps. After submission, you can expect a follow-up by email outlining the process and options for moving forward.

Parent/Caregiver Name *

Email Address *

Phone Number

For scheduling or clarification questions

Child's Name *

Child's Age *

Primary concerns (brief) *

Briefly describe what prompted you to seek an evaluation (for example: attention/executive functioning, learning, anxiety, autism-related concerns, emotional/behavioral regulation, or social communication).

What are you hoping an evaluation would help clarify? *

How did you hear about the practice?

Are you an existing client? *

Yes

Submit

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