New Client Evaluation Request

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Please complete the questions below so our team can review your concerns and guide you toward the most appropriate next steps.

Today's Date *

YYYY

Who is completing this form? *

Parent / Guardian seeking evaluation for child / teen

Adult Client (18-21)

College student seeking evaluation for self

School District seeking evaluation for student

Other:

What state does the individual live in? *

New Jersey

Pennsylvania

Other

What is the age of the individual to be evaluated? *

We do not provide services for individuals under the age of 5.

5-6

7-11

12-17

18-21

Other:

What evaluation type has been requested or discussed (if any)? *

Evaluation types are often labeled differently depending on the setting it is used for (school, college, etc. ). If you’re unsure, you may choose "not sure" — An initial intake review explores your concerns and helps determine the most appropriate option before you move forward.

Clinical & Diagnostic Evaluation (ADHD, Autism, Learning Disability, Anxiety, Depression)

School-Related / District Funded Evaluation (Independent Educational Evaluation [IEE], IEP Updates, 504 Plans

Academic Accommodations & High Stakes Testing (SAT, ACT, LSAT, GRE, MCAT, College Courses, Bar Exam)

Admissions and Gifted Testing (Private School or School Gifted Programs)

I’m not sure which evaluation is most appropriate and would like your recommendation

Required

What are the primary areas of concern? *

Select all that apply — this helps us understand your most important concerns. An initial intake review explores your concerns and helps determine the most appropriate option before you move forward.

Attention & Organization (ADHD, focus, impulsivity, executive functioning)

Reading, Writing, or Math (Dyslexia, Dysgraphia, Dyscalculia, general learning struggles)

Social & Communication Skills (Autism Spectrum, speech/language concerns)

Emotions & Mood (Anxiety, depression, behavioral challenges, emotional regulation)

Memory & Cognitive Processing (Slow processing speed, memory difficulties, IQ testing)

General School/Work Difficulties (Struggling academically or professionally, but cause is unclear)

Self-Improvement & Personal Goals

Not Sure / Please Advise

Required

Does the individual have a history of *

Medical Condition or Diagnosis

IEP

504 Plan

None of the Above

Required

Any additional services or preferences needed? *

Expedited Report

School Classroom Observation

In-Person Testing

Online / Virtual Testing

Review Results at IEP Meeting

None

Required

What best describes your situation? *

General concerns (not urgent)

Prior evaluation — need updated testing

School difficulty escalating

Due process / dispute with school

College documentation needed

Self-improvement / personal goals

None

Required

Do you have a deadline you are trying to meet? *

No specific deadline

Yes - within 1-2 months

Yes - within 3-4 weeks

Yes – urgent / expedited (needed within 2–3 weeks)

Required

How do you plan to pay for this evaluation? *

Leonard Evaluations does not participate in insurance plans. We do not take insurance.

Private Pay (credit card, cash, check)

School District Funding / IEE

I only want to use insurance so I will not be proceeding any further.

Required

Based on your information, which level of evaluation best fits your needs right now? *

This selection is not final. Our team reviews every request and helps confirm the most appropriate evaluation before moving forward. Final scope and cost are determined after review of the intake information and clarification of needs.

Basic Evaluation - A brief screening for a very specific question. ✔ Helpful for ruling concerns in or out. ✔ Appropriate when needs are narrow and well-defined. X Not intended for multi-area diagnosis, complex profiles, or if recommendations are needed (Starting at $250-$500)

Standard Evaluation - An in-depth evaluation focused on one main area (such as ADHD, learning disability, or emotional concerns), including symptom clarity and practical, targeted recommendations. ✔ Ideal when concerns are focused and well-defined. ✔ May be sufficient for supports or accommodations in school, college, or the workplace (Starting at $1,500–$3,000)

Comprehensive / IEE -A highly individualized evaluation designed to understand how learning, attention, emotions, and executive functioning interact, especially when prior testing, diagnoses, or school supports have not fully explained the challenges. ✔ Examines multiple possible explanations, not just one label. ✔ Integrates cognitive, academic, emotional, and executive functioning findings to get to the root of the issue. ✔ Provides comprehensive recommendations that clarify next steps and support confident decision-making over time (Starting at $2,000–$6,000, depending on scope)

Not sure which evaluation is most appropriate? – That’s very common. Select this option and our team will review your information and help recommend the best evaluation, timeline, and next steps.

I’ve reviewed the information and do not want to move forward at this time

Required

First & Last Name *

Email Address *

Phone *

Zip Code *

After reviewing the evaluation options, pricing, and policies above, which best describes where you are right now? *

I am ready to move forward with an evaluation and understand the next step is completing a retainer to secure services.

I am interested in moving forward and would like clarification on a few questions before proceeding. I would like to schedule a brief (10-minute) phone call.

I am still exploring options or comparing services and am not ready to move forward at this time.

I am not planning to move forward with an evaluation and do not need follow-up at this time.

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