• Please take a few minutes to complete this form.

    This information is required so that we can best prepare for your testing appointment and foster a happy, supportive, and successful experience.
  • Gender*

  • Handedness*

  • Does your child use hearing aids?*
  • Does your child have any known visual challenges or wear glasses?*
  • Does your child have any fine motor challenges? (i.e. using a spoon, coloring/writing, zipping)*
  • Does your child have any severe allergies or aversions?*
  • Has your child participated in cognitive/academic testing within the last year?*
  • Does your child take any medication daily? If yes, please discuss with tester. Some medications (prescription or OTC can impact testing)*
  • When your child has to separate from you, which best describes him/her?*

  • Has your child been sick, especially upset, or experienced sleep/eating/toileting or behavioral disturbance recently? *

  • Parent/Legal Guardian essentials

    Parent/Legal Guardian essentials

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  • Please provide your consent to send results in the following formats*

  • I would like expediting if available (results within 4 business days) for an additional fee of $75.00 Please note that tester will confirm availability, as this feature is schedule-dependent.

  • We do not test sick children. If your son or daughter is within the first 48 hours of taking a prescribed antibiotic, has a rash or viral infection, has vomitted or had a fever within 72 hours, or has any known COVID-19 exposure or possible flu, Covid, cold, or other symptoms, we require rescheduling. We are dedicated to finding a spot for you when your little student is feeling better!

  • If a school contacts us to discuss the test findings, we would like permission to do so. If you are agreeable, please indicate.*

  • Appointment status*

  • Parent's signature indicating acknowledgment of the policies reviewed in this document, truthful reporting, agreement to pay associated fees, and consent to evaluate:

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  • Should be Empty: