Psychological Evaluation Referral Form 
“Why can’t I ever feel happy?”
“Why do I keep doing the same things over and over again, even when I know better?”
“It seems like we’ve tried everything and nothing helps … now what
“I just want to learn more about who I am and how I think about things.”
These are all situations when a formal evaluation can be very helpful.
During a psychological evaluation, clinical psychologists explore how a person thinks, feels, and behaves in relation to themselves and the world around them. It is a process of discovery that is particularly helpful when other clinical interventions and services have been tried, without significant success. It involves the integration of information from multiple sources, such as tests of normal and abnormal personality, tests of ability or intelligence, tests of interests or attitudes, behaviors as well as information from personal interviews. Collateral information is also usually collected about personal, occupational, or medical history, such as from records or from interviews with parents, spouses, teachers, or previous therapists or physicians. We gather information and formulate a specific plan for intervention that builds upon strengths and available resources.
Some evaluations are designed to obtain general personality / cognitive / interpersonal / behavioral functioning levels, without any specific questions or concerns to be addressed.This is helpful when starting out in therapy or some form of intervention and the person, family or clinician would like a baseline “snapshot” of functioning.
Other evaluations are more specific, focusing in on a particular behavior or cluster of behaviors that have not been adequately explored or understood, or have persisted despite participation in treatment/community intervention.
After the evaluation is complete, I will schedule a time with you to review results and answer any questions.
The results of a psychological evaluation are typically summarized in a report that includes:
~ Presenting information and psychosocial history
~ Personal strengths/obstacles as well as coping skills/deficits
~ Cognitive and personality functioning
~ Interpersonal dynamics
~ Clinical/Diagnostic conceptualization
~ Prognosis/Recommendations
Specialized evaluations address specific clinical circumstances, such as :
~ Family communication and interpersonal patterns
~ Parental abilities including strengths and limitations
~ Independent Living Skills / Adult competency determination
~ Cognitive functioning/IQ only ($300)
~ Substance use/abuse evaluation ($300)
The referral process is simple and quick:
~ Complete and submit an Evaluation Referral Form (.pdf)
~ Insurance claims can be filed by FICUS staff
~ Appointments are frequently available within two weeks
RATES are variable (typically between $500 – $1000), based on:
~ type of evaluation requested
~ a brief or extensive report
~ testing location (if different than at the Roanoke office)
~ Insurance may cover all or a portion of the evaluation cost
Feel free to contact me for more information or consultation @ 540-342-2592 or debra@ficuscenter.com
