N-648 Pre-Evaluation Screening
Language
  • English (US)
  • Urdu
  • Vietnamese
  • Spanish (Latin America)

  • N-648 Pre-Evaluation Screening - English

  • 648 Pre-Evaluation Screening

    **SERVICE SCOPE NOTICE** This Pre-N648 educational screening is available to residents of Texas and Louisiana only. Clinical evaluations are available exclusively in Texas.

  • 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.

  • Service Description

  • 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.

  • 🧾 Research Participation

    Help Improve Services for Future Applicants

  • 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.

     

  • 📝 Your Consent Decision

    Please select one option below:
  • Please select one option below:

  • 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.

  • DEMOGRAPHICS & CONTACT INFORMATION

  • What state do you currently reside in?*

  • 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

  • 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.

  • Format: (000) 000-0000.
  • What is your gender, as it appears on your legal identification (for immigration purposes)?
  • How is your racial or ethnic background classified under U.S. immigration categories? (Check all that apply. This is optional and used for documentation purposes.)
  • How would you prefer to receive your screening results?*
  • Format: (000) 000-0000.

  • Initial Qualification

  • Q1: Are you applying for citizenship?*

  • 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.

  • Q2: Are you 18 years or older?*

  • 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.

  • Q3: How long have you been a permanent resident of the US?*

  • 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.

  • Medical History

  • 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.

  • Q4: Do you have any diagnosed medical conditions? (Check all that apply)
  • Q5: Do you experience any of these symptoms, even if not formally diagnosed? You may select experiences that have happened in the past or are currently affecting you. Your answers help us understand if you think additional evaluation might be helpful. (Check all that apply)
  • Q6: Overall, how much do ALL of your conditions/symptoms combined interfere with your daily life?
  • Q7: How long have you had these conditions or symptoms?
  • Q8: When did you first notice these problems?

  • Medication History

  • Q9: Are you currently taking medications that affect your memory, concentration, or thinking?
  • Q11: Which types of prescription medications do you take that affect thinking/memory? (Check all that apply)
  • Q12: How long have you been taking these medications?
  • Q10: Do you take any over-the-counter (non-prescription) medications or natural remedies to help with memory, focus, sleep, anxiety, or mood? (Examples: Tylenol PM, melatonin, herbal teas, vitamins, or pain medications)

  • Medical Records

  • Q13: Do you have medical records documenting your condition(s)?

  • Healthcare Access Barriers

  • Q14: Are you currently able to access and maintain consistent medical treatment?
  • Q15: Barriers that keep you from accessing the healthcare you need? (Cheek all that apply)
  • Q16: Have any of these factors affected your medical care or documentation?"
  • Q17: Do you feel comfortable communicating about your medical needs with healthcare providers?

  • 🔒 CONFIDENTIALITY ASSURANCE
    This screening is confidential, and your immigration status does not affect the quality of recommendations you'll receive. Your privacy is protected, and this information helps us provide better guidance.

  • 🌍 CULTURAL SENSITIVITY
    We recognize and respect cultural differences in healthcare experiences, and we will provide recommendations that take into account your cultural background and preferences.

  • ASSISTIVE DEVICES AND ACCOMMODATIONS

  • Q18: Do you currently use any assistive devices? (Check all that apply)?
  • Q19: When using your assistive devices, how well do they help?

  • 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.

  • Learning Capacity (i.e., memory, comprehension, and processing speed)

  • 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
  •
  • Q21: Did you need help completing this screening form? (This includes help with reading, writing, understanding the questions, using an interpreter, or getting emotional support while answering.)

  • Education & Language History

  • Q22: What is your highest level of education?
  • Q23: In what language was your education?

  • U.S. Citizenship Exam History

  • Q24: Have you attempted to study for the citizenship test?
  • Q25: Have you taken the citizenship test (English and/or civics)?
  • Q26: If you haven't taken the test yet, why not?
  • Q27: If you failed the test, what parts were most difficult? (Check all that apply)?
  • Q28: Have you previously attempted to receive an N-648 waiver?
  • Q28: How well do you understand spoken English?
  • Q30: How well can you speak English in a conversation?
  • Q31: Can you read and write in your first language?
  • Q32: Have you taken any English or citizenship classes before?
  • Q33: Do you believe your difficulty learning English is due to a medical, mental health, or memory-related condition?

  • PROFESSIONAL REFERRAL PREFERENCES

  • Q34: Would you like us to provide you with referrals to qualified professionals?
  • Q35: Do you currently have an immigration attorney?
  • Q36: Preferred location for professional services:
  • Q37: If screening indicates strong clinical indicators, when would you be ready for a comprehensive evaluation?

  • Response Verification:

  • Please confirm your responses are complete and accurate.*

  • **UNDERSTANDING YOUR RESULTS**

  • 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).

     __________________________________________________________

     

  • Consent to Follow-up

    We need your help to improve our services for customers
  • May we contact you for quality assurance or outcome tracking purposes?

  • PAYMENT AND FINAL DISCLAIMER

    NO GUARANTEE OF RESULTS: This educational screening does not guarantee approval of any N-648 application or USCIS decision. Based on your responses, the professional screening indicates your likelihood of obtaining an N-648 waiver, but individual circumstances may vary.

    SCREENING FEE: $150.00. Payment is required to receive your detailed screening results and professional recommendations.

  • PAYMENT DETAILS

    N-648 Pre-Evaluation Screening........................$200.00
    Secure Payment Processing Fee...........................$5.00
    TOTAL DUE................................................$205.00

  • Pre-N-648 Evaluation Screening Report

    prevnext( X )
        Pre-N-648 Evaluation Screening Report
        $200.00$200.00
          
        Secure Processing Fee
        $5.00$5.00
          
        Total
        $0.00$0.00
      • Should be Empty: