We are reaching out to you because you have been identified as a professional involved in the care of this child/adolescent including but not limited to behavioral therapist, school social worker, occupational therapist, physical therapist, speech/language therapist, or psychiatrist. This individual will soon participate in a neuropsychological evaluation at the Pediatric Mindworks Center (PMC), part of HRA Psychological Services.
Upon the family's request and permission, we are seeking information about your experience working with this individual. As member of the patient's care team, your observations and impressions are valuable as we seek to offer differential diagnosis and understanding of this patient's experience in the upcoming assessment.
We kindly ask that you complete this form and provide a copy of relevant records that would be helpful to review as part of this assessment. We also welcome any additional information you wish to share. Please know that this information may be integrated into the final report.
This form can be submitted directly online. Your time and cooperation are greatly appreciated!