FERS DISABILITY PSYCHOLOGICAL EVALUATION INQUIRY

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.

IMPORTANT: We do NOT provide guidance, advice, advocacy, or assistance with filing for disability. Our practice only provides Independent Psychological Evaluations to provide an opinion related to a psychiatric disability and its impact on performance of essential functions. You must have records for the past several years, including treatment records, prior mental health evaluations/records, medication/diagnosis history, position description/essential duties, prior workplace performance evaluations documenting the performance issues, disability statements, leave documentation from work, accommodation documentation, performance-related documentation, supervisor statement, agency correspondence, etc. available for upload, if we agree to conduct a review of records and possible evaluation. If you do not have access to this, please discuss with a qualified professional, obtain records, and then re-request consultation in the future. Thank you.

Are you located in a PSYPACT state? Thisincludes: 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

Are you represented by an attorney for this matter?

Yes

Please discontinue request and have your attorney contact us directly to discuss the case/request evaluation services.

Provide Dr. Rodriguez with some brief information about your evaluation needs.

Email address

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

Yes

This consultation request form does NOT create a doctor patient or other client relationship and is for informational purposes only. It is not to be used for any urgent or emergency mental health needs. In the event of urgent mental health needs, including thoughts of harm to self or others, please go to the nearest emergency room for an evaluation and/or contact your local emergency services (911) or call the crisis hotline at 988.

Yes I understand and agree to the above.

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FERS DISABILITY PSYCHOLOGICAL EVALUATION INQUIRY

FERS DISABILITY PSYCHOLOGICAL EVALUATION INQUIRY

FERS DISABILITY PSYCHOLOGICAL EVALUATION INQUIRY

Amica Clinical Consulting PLLC