• Psychological Testing Center

    Psychological Testing Center

    Interest & Sign-Up Form
  • Who is being assessed?

  • Have you seen us before?

  • Age

  •  - -
    Pick a Date
  • Sex/gender

  • Contact info

  • Home address

  • Type of Assessment

  • Court/Legal Disclosure**

  • Insurance provider

  • Please provide your member ID / policy #  in the box below. 

    (For Tricare members, please provide your " Benefits # ") 

    Need help? The benefits number can be found on the back of your DOD ID in the upper-lefthand corner.  

  • Scheduling Preferences

  • Anything else we should know?

  • Should be Empty: