FERS DISABILITY PSYCHOLOGICAL EVALUATION INQUIRY

This inquiry form should by used ONLY by attorneys/their offices seeking evaluation for their clients. This form should not be used by clients/patients directly.

Thank you for reaching out. To best assist you, please complete the information below. Dr. Rodriguez will review the inquiry. If a phone call might be helpful, she'll reach out to schedule a time to discuss. Consider including some good days/time to reach you and a phone number.

Is your client located in a PSYPACT state? This includes: AL, AZ, AR, CO, CNMI, CT, DE, DC, FL, GA, ID, IL, IN, KS, KY, ME, MD, MI, MN, MO, MS, MT, NE, NV, NH, NJ, NC, ND, OH, OK, PA, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, and WY Please check for updates on PSYPACT states here: https://psypact.gov/page/psypactmap

Yes

If not located in a PSYPACT state, please do not proceed as we cannot legally provide evaluation services

Provide Dr. Rodriguez with brief info/general questions about the request and best contact information:

Email address

Do you consent to us responding to you via secure email?

Yes

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FERS DISABILITY PSYCHOLOGICAL EVALUATION INQUIRY

This inquiry form should by used ONLY by attorneys/their offices seeking evaluation for their clients. This form should not be used by clients/patients directly.

This inquiry form should by used ONLY by attorneys/their offices seeking evaluation for their clients. This form should not be used by clients/patients directly.

Amica Clinical Consulting PLLC