Professional Inquiry Form
FOCUS OC CONSULTING PROFESSIONAL REFERRAL INQUIRY Form Description: This form is intended for attorneys, school districts, and other professional referral sources who wish to inquire about evaluation or consultation services through Focus OC Consulting. Please provide the information requested below so that Focus OC Consulting can determine whether the referral is appropriate and contact you regarding next steps. Important: Please do not submit confidential educational records, medical information, or other highly sensitive documents through this initial inquiry form. Submission of this form does not establish a professional relationship or guarantee acceptance of the referral.
Full Name
*
First Name
Last Name
Professional Role
*
Please Select
Attorney
School District Representative
School Psychologist
Educational Professional
Other
Organization, Law Firm, or School District
*
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Student/Client Information
Student/Client Name
*
Student/Client Age
Current Grade
Please Select
Preschool
Kindergarten
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Referral Details
Type of Service Being Requested
*
Psychoeducational Evaluation
Independent Educational Evaluation (IEE)
Functional Behavior Assessment (FBA)
Educationally Related Mental Health Services (ERMHS) Evaluation
Educational Consultation
Records Review
Other
Reason for Referral / Brief Description of Needs
*
What is the context of this referral?
Private evaluation
Attorney-referred evaluation
Potential Independent Educational Evaluation (IEE)
School district referral
Special education matter
General education concern
Other
History and Timing
Has the student/client previously received an educational or psychological evaluation?
*
Yes
No
Unsure
Is there a specific deadline or desired timeline for this referral?
*
No specific deadline
Within the next 2–4 weeks
Within 1–2 months
Specific deadline
Is an attorney currently representing the parent/client?
Yes
No
Unsure
Attorney and Contact Preferences
Professional Referral Inquiry Notice
Attorney Name
Law Firm
Contact Information
Preferred Method of Contact
*
Email
Phone
Either
Additional Information or Questions
Submit
Should be Empty: