Follow the steps to complete the online form efficiently.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering today’s date in the designated field. This ensures that your request is current and reflects the most timely information.
3. In Section I, fill out the enrollee's name, member number, and date of birth. This information is crucial for identifying the individual requesting the testing.
4. Proceed to Section II to indicate the requesting provider information. Select the appropriate role such as psychologist, parent, or teacher. If your role is not listed, specify it in the provided space.
5. In Section III, input the testing provider's information. Include their name, phone number, degree, fax number, address, and email. Accurate contact details will facilitate communication.
6. Section IV requires you to enter current or provisional DSM-IV diagnoses. Input the diagnosis codes along with descriptions. If there are any relevant Axis III conditions, list them clearly.
7. Section Va asks you to articulate the specific question that the testing will address, which cannot be determined through usual evaluations. Be as detailed as necessary to clearly convey the issue.
8. In Section Vb, outline the current symptoms related to the testing question to provide additional context for the evaluator.
9. Section VI requests an explanation of how the testing results will affect the treatment plan. Detail how the outcomes are expected to guide future actions.
10. Sections VII and VIII inquire about past evaluations, current medication, and substance use. Complete these sections truthfully to provide a comprehensive background.
11. In Section IX, indicate the requested testing hours and specify if the testing is primarily neuropsychological. List the names and types of tests, as well as the anticipated start date for testing.
12. If a technician is administering the tests, ensure that Section X is completed, including the signature of the supervising psychologist to confirm oversight.
13. After reviewing all filled sections for accuracy, save your changes, then download, print, or share the completed form as required.

Ensure your psychological testing request is thorough and well-prepared—complete your forms online today!