*Please review referral with supervisor prior to completiong; your supervisior may be contacted regarding referrals received as needed.
IF YES: active substance abuse impacts the validity of psychological testing, and testing will not be scheduled by CBI if this is indicated.
IF YES: use of marijuana (medical or recreational) impacts the validity of psychological testing and therefore it is not recommended if used regularly.
IF YES: a copy of past psychological testing must be provided to CBI prior to scheduling.
IF YES: In making this referral, I agree to coordinate a plan with my patient priorto psychological testing services. The validity of testing results can be impactedwhile my patient is taking these medications and I agree to discussion of this withmy patient prior to testing services.
IF YES: This should be pursued first.
IF YES: Safety-related concerns should be considered primary prior to psychologicaltesting services. Testing will not be scheduled by CBI if indicated.