Patricia Beldotti, Psy.D.
Licensed Psychologist, Neuropsychologist

New Patient Intake Form
If interested in an assessment appointment, please fill out the form below & submit.  Someone will contact you to discuss your assessment needs.
Rather have a paper form to mail or fax in?  Click Here  
Please identify type of evaluation (click here for list) / purpose of evaluation (check all that apply)
Once you have completed the form, press the SUBMIT button.  The information will be reviewed and someone will contact you soon to discuss your evaluation needs further.
#1: Evaluation for diagnostic purposes for possible ADHD, Autism, & related psych issues
#2: Evaluation for possible learning disabilities (reading, writing, math, dyslexia, dysgraphia, etc.)
#3: Expanded evaluation of possible ADHD/ASD and LD (#1 & #2 together)
#4: Evaluation for Intellectual Disability
#5 or #6: Evaluation for Giftedness (#5: IQ; #6: IQ & Academics)
#7: Psych Evaluation for clearance for adoption
#8: Clarification of cognitive functioning (due to thinking changes from known or unknown causes)
Evaluation results required for disability determination
Evaluation results needed to qualify for accommodations or support at school
Evaluation results needed to receive accommodations at work
Evaluation results needed to receive accommodations on standardized testing (SAT, LSAT, MCAT, etc.) or licensure exams, etc.