Neuropsychology

Initial Inquiry Questions


INITIAL INQUIRY QUESTIONS: Please provide us with the following information so that we can determine how to best proceed in scheduling appointments and evaluating your child. This information is essential for us to move forward, though it does not guarantee an appointment with Dr. Schmidt. Our office will contact you once we have reviewed your initial inquiry to talk with you in greater detail about your child and how we can best meet his or her needs.  All information provided will remain confidential.

Parent 1 Name
Parent 1 Name
Parent 1 Phone
Parent 1 Phone
Parent 1 Mailing Address
Parent 1 Mailing Address
Parent 2 Name
Parent 2 Name
Parent 2 Phone
Parent 2 Phone
Parent 2 Mailing Address
Parent 2 Mailing Address
Childs Name
Childs Name
Childs Date of Birth
Childs Date of Birth
Current School Address
Current School Address
Current School Phone
Current School Phone
Funding arrangement for the evaluation you are seeking