Clone of Schedule My Evaluation

This secure form is used to request a one-time psychological evaluation for documentation purposes (e.g., FMLA, disability, or accommodation letters).

This service does not establish a therapeutic relationship and does not provide ongoing therapy, crisis intervention, or emergency support.

Please answer all questions carefully. Requests that do not meet eligibility criteria will not be scheduled.

Full Legal Name*

First NameLast Name

Email*

Confirmation Emailexample@example.com

Phone Number*

Please enter a valid phone number.

Are you currently located in California?*

YesNo

Services are limited to California Residents.

What type of documentation are you requesting?*

FMLADisability (CA SDI or private insurer)Workplace Accommodation LetterSchool Accommodation Letter

In 1-3 sentences, briefly describe what you are requesting documentation for. Please do not include detailed history, trauma narratives, or crisis information.*

Do you already have the form that needs to be completed?*

Yes - I have the form and submission instructionsNo - I will obtain the form and instructions before schedulingI am requesting a narrative letter only (no form)

Evaluations cannot proceed until required forms and instructions are provided.

When do you need the documentation completed by?*

Standard timeline (5-7 business days)Rush Request (24-48 hours, additional fee)Rush Request (48-72 hours, additional fee)

I understand this is a one-time evaluation service, not ongoing therapy.

I understand documentation is completed only when clinically supported and approval is not guaranteed.

I understand that service is self-pay, and fees are due prior to the appointment.

I am not requesting documentation from an existing treating provider.

I understand this service does not provide crisis or emergency care.

I understand that payment covers the evaluation appointment regardless of whether documentation, forms, or letters are completed. Fees are non-refundable once the evaluation is scheduled.

If you are experiencing a mental health emergency, please call 988 or go to your nearest emergency room.

Full Vida Therapy provides evaluation-only documentation services in accordance with ethical and legal standards for mental-health practice in California.

Schedule a Documentation Evaluation