Your student will soon participate in a neuropsychological evaluation at the Pediatric Mindworks Center (PMC), part of HRA Psychological Services. The family/care-providers have requested your assistance by completing this written consultation. While testing data is useful, collateral information from sources close to the student offer a wealth of information that cannot be captured in our offices. Therefore, the following information will be vital to understanding your student's academic functioning while providing valuable observations about their social-emotional and behavioral wellbeing.

We have also asked the family/care-providers to supply relevant school records to aid in our conceptualization of your student. These records may include IEPs, Section 504 plans, behavior plans, assessments, or other documents. If you could assist thefamily/care-providers in obtaining such records to share with PMC, it would be appreciated. It will be especially important to know if any recent assessment by a school psychologist or other such provider has been conducted as we do not want to duplicate their efforts.

PMC also welcomes any additional information you wish to share. Please know that this information may be integrated into the final report. Your time is precious and so we have carefully selected the following questions or forms to make this request reasonable. Thank you in advance for your timely completion of this form and any attached rating scales.

This form can be submitted directly online. We very much appreciate your dedication to this process to help this student!