N-648 Pre-Evaluation Screening - English

CONFIDENTIALITY NOTICE
Your privacy is protected. Information provided in this screening is confidential and will only be used to offer guidance regarding your potential eligibility for a disability waiver if you decide to have an N-648 evaluation. Your information will not be shared with third parties without your written consent.

IMPORTANT DISCLAIMER
This screening is for informational purposes only and does not constitute a medical diagnosis, psychological evaluation, or legal advice. Based on your responses, the professional screening indicates your likelihood for N-648 qualification. Final determination requires formal evaluation and USCIS approval.

This screening is an educational consultation that provides professional recommendations based on your responses. It is not a clinical evaluation or legal advice, but rather expert guidance to help you understand your options and connect with appropriate providers.

Why We’re Asking

SHIFT Behavioral Health may, in the future, analyze anonymized screening data to understand the needs of immigrant communities better and improve our services. This research may support professional publications or community education.

What This Means

We are requesting your permission to use your screening answers—with your name and all personal details removed—as part of research that may be shared in professional journals or educational settings. Your participation helps us better serve others.

🔐 Your Rights and Protections

Voluntary – Your decision does not affect your screening or services
Anonymous – All identifying information will be removed before analysis
Confidential & Secure – Data is stored in encrypted, password-protected systems
Revocable – You can withdraw your consent at any time without explanation

Your screening experience remains the same whether or not you choose to participate in this research.

By selecting an option, I confirm that:

I understand this research is optional and separate from my screening service
I can withdraw consent at any time
I can contact SHIFT Behavioral Health with questions

Research Supervisor: Dr. Paula Trammell Harris, Licensed Clinical Psychologist
📧 ptharris@shiftbehavioralhealth.org | 📞 832-666-4405
📄 Texas License #: 38700

This research consent is separate from the privacy protections that apply to your screening service, which adhere to psychology ethics and applicable laws.

We currently serve Texas and Louisiana residents only. Please get in touch with qualified providers in your state for guidance on N-648.

SERVICE AREA LIMITATION

Thank you for your interest in our Pre-N648 Educational Screening service.

Currently, Shift Behavioral Health provides N-648 screening services exclusively for residents of Texas and Louisiana. This limitation allows us to:

 Maintain expertise in state-specific healthcare systems
 Ensure familiarity with regional USCIS processing patterns  
 Provide accurate referrals to local medical and legal professionals
 Deliver the highest quality recommendations for your area

For questions about this service limitation, contact Shift Behavioral Health at                     📧 info@shiftbehavioralhealth.org | 📞 832-666-4405.

Thank you for your interest in our Pre-N648 screening service.

CITIZENSHIP REQUIREMENT -Exit Form

N-648 medical waiver evaluation applies specifically to individuals applying for U.S. citizenship.

RECOMMENDED NEXT STEPS:

• Determine your eligibility timeline for the citizenship application.
• Consult with an immigration attorney about your options.
• Contact us when you're ready to apply for citizenship.

Contact us if you have questions:

Shift Behavioral Health 

  |info@shiftbehavioralhealth.org | 📞 832-666-4405.

Thank you for your interest in our Pre-N648 screening service.

AGE REQUIREMENT NOTICE - Exit Form

N-648 medical waiver evaluation is available for adult citizenship applicants aged 18 and above. Minors have different accommodation options through the citizenship process.

RECOMMENDED NEXT STEPS:

• Consult with an immigration attorney about minor accommodations
• Contact USCIS directly about special considerations for minors
• Consider waiting until age 18 to pursue an N-648 evaluation
   

Contact us if you have questions: 

 Shift Behavioral Health  |info@shiftbehavioralhealth.org | 📞 832-666-4405.

Thank you for your interest in our Pre-N648 screening service.

RESIDENCY REQUIREMENT NOTICE - EXIT FORM

Citizenship applications require permanent residence for at least 3 years (if married to a U.S. citizen) or 5 years (general requirement).

RECOMMENDED NEXT STEPS:

• Calculate your eligibility date for the citizenship application
• Use this time to gather medical documentation if needed
• Contact us when you meet the residency requirement

We look forward to assisting you when you're eligible to apply.

Contact us if you have questions:

info@shiftbehavioralhealth.org | 📞 832-666-4405.

Note: We are asking specifically about medications that affect your thinking, memory, or concentration. This does NOT include common medications for diabetes, blood pressure, or cholesterol unless they cause cognitive side effects.

IMPORTANT REMINDER FOR ANY FUTURE EVALUATION:
You MUST bring all assistive devices (glasses, hearing aids, etc.) to any evaluation appointment. Testing without your necessary aids could result in inaccurate results and may require rescheduling your appointment.

Q20: Rate your difficulty with these learning and cognitive abilities:
(0=No difficulty, =Cannot do at all).

•  0: No difficulty - Can perform easily without any problems or limitations
• 1: Minimal difficulty - Slight problems that rarely interfere; can usually work around the
• 2: Mild difficulty - Noticeable problems that sometimes interfere; may need extra time or effort
• 3: Moderate difficulty - Significant problems that regularly interfere; often need help or accommodations
• 4: Severe difficulty - Major problems that consistently interfere; usually cannot do without significant help
• 5: Cannot do at all - Unable to perform the activity even with maximum help or accommodations

Your screening will result in one of four Clinical Indicator levels:

• Strong Clinical Indicators (pursue N-648 evaluation)
• Moderate Clinical Indicators (strengthen documentation first)
• Limited Clinical Indicators (consider alternative approaches)
• Minimal Clinical Indicators (traditional citizenship path recommended)

Each level includes specific professional recommendations for next steps.

**Your report will consist of:

• Clinical Indicator Level based on comprehensive analysis
• Detailed review of your particular medical and functional factors
• Professional recommendations tailored to your situation
• Referral guidance and next steps appropriate for you
• Written documentation that you can share with attorneys or healthcare providers 

**Delivery Method:**

Results will be sent via your selected preference (email, phone, pickup, or mail).

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