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CReATE Professional Referral Form (Child/Adolescent)
CReATE Professional Referral Form (Child/Adolescent)
CReATE Professional Referral Form (Child/Adolescent)
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  • English (US)
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    CReATE Professional Referral Form (Child/Adolescent)

    Please tell us a little more about the child so we can better understand their needs for testing. If you have difficulties with this form, please call our office at 828-231-3297

    The information submitted in this form is guaranteed to be kept confidential and secure. Please wait for the confirmation page to appear once you submit your form.


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    • Male
    • Female
    • Other
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    • English
    • Spanish
    • Russian
    • Chinese
    • French
    • Arabic
    • Other
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    • Biological Parent
    • Adoptive Parent
    • Step Parent
    • Foster Parent
    • Grandparent
    • Guardian
    • Other
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    • Yes
    • No, please just send report
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    • Yes
    • No
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    Please check one or all that apply:
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    (check all that apply)
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    (check all that apply)
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    This may include a copy of your assessment, medical records, school records, mental health records, application for the client/patient to attend your program, prior testing, etc.) Please upload any previous psychological/psych-educational testing that would be relevant to the client's assessment at CReATE by clicking the "Browse Files" button below, and selecting the file from your computer (if not applicable, please skip):
    Drag and drop files here
    Select files to upload
    Max. file size: 10.6MB
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    Thank you for completing this form. The information submitted is guaranteed to be kept confidential and secure.

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