Registration Packet

What to Expect

The purpose of the initial consultation is to gather information to make an accurate diagnostic impression and to develop a comprehensive treatment plan. This process includes obtaining an extensive history of concerns from the client’s caregivers, reviewing any former testing or relevant reports from other providers or schools, interacting with the client, and scoring standardized assessment tools. The initial visit is scheduled for 80 minutes. A visit summary will be provided at your follow up appointment or by another means if necessary.

What to Bring

Please bring copies of the following documents (if applicable) or any other items you find relevant to promote the most efficient and thorough evaluation:

  • Psychological or psycho-educational testing reports

 

  • School 504 plans, IEPs, report cards, progress notes, agenda notebooks, behavior intervention plans

 

  • Standardized screening tools (parent and teacher) included in your intake packet

 

  • Progress notes from therapists or counselors

 

  • Early intervention evaluation reports

 

  • Medical records from former specialists

 

 

Assessment Questionnaires: (fill out what is relevant for you or your child)

 

1) NICHQ Vanderbilt Assessment Scale – Parent Informant (child should fill one out, too, if age 12+) (pages 2 & 3)

 

2) NICHQ Vanderbilt Assessment Scale – Teacher Informant *this is needed for diagnostic criteria (pages 4 & 5)

 

3) PHQ9 Depression Questionnaire – to be filled out by clients age 12+ if concerns of depressed mood

 

4) SCARED Anxiety Questionnaire – Parent Version

 

5) SCARED Anxiety Questionnaire – Child/Teen Version

© Music City Peds: Developmental & Behavioral Medicine 2016