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Make a Referral

Physicians, therapists, psychiatrists, schools, and other providers can refer clients ages 6 and older for autism and ADHD evaluations and other psychological testing, including neuropsychological measures of attention, memory, and executive functioning. Send your referral through the secure form below and we'll reach out to your client to schedule a testing intake.

Provide Collateral Information

As part of the comprehensive psychological evaluation process, we gather information from individuals who know the client and can provide valuable insight into their behaviors, symptoms, strengths, and daily functioning. This questionnaire is intended for parents, family members, teachers, school counselors, mental health providers, and other individuals familiar with the client. Your observations help us better understand the client's experiences across different settings, identify potential areas of concern, and support accurate diagnostic impressions and individualized recommendations. Please answer the following questions based on your knowledge and personal observations of the client. Your input is greatly appreciated and plays an important role in the evaluation process.

Secure referral form

Takes about 5 minutes. Please make sure your client, or their parent or guardian, knows about the referral and has agreed to be contacted. Don't send referral information by regular email.
 

Evaluations are for clients ages 6 and older. Please don't use this form for urgent or crisis needs; call 911 or 988 instead.

Referring provider

Your role
Physician
Therapist/counselor
Psychiatrist
School
Other

Client Information

Birthday
Month
Day
Year
Reason for referral
The client (or parent/guardian) knows about this referral and agrees to be contacted by Rock Springs.
Yes
No
With the client's consent, would you like to be notified when they are scheduled?
Yes
No
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Secure collateral form

Takes about 5 minutes. Please make sure your client, or their parent or guardian, knows you are providing collateral information and has agreed.
 

Evaluations are for clients ages 6 and older. Please don't use this form for urgent or crisis needs; call 911 or 988 instead.

collateral form anchor
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