Psychological Testing Waitlist
Name
First Name
Last Name
Legal Name (if different)
First Name
Last Name
Pronouns
she/her, he/they, etc.
Date of birth
-
Month
-
Day
Year
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Where are you located?
*
City, State
Why are you interested in testing at this time?
Academic accommodations
Work accommodations
Diagnostic clarity
Medication - We DO NOT prescribe medication, but psychiatrists may require formal psychological testing/assessment before they prescribe medication
Other
What type(s) of testing are you interested in?
ADHD
Autism
Cognitive/intelligence
Learning disabilities
Mood disorders (depression, anxiety, bipolar, etc.)
OCD
Personality
Not sure
Other
Would you prefer a virtual or in-person appointment? Please keep in mind in-person would be at our office in Houston, Texas.
Virtual
In-person
Either/no preference
Is there any other information you would like to share with us?
Submit
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