School Psychologist Referral Form

Facilitate effective student support with this detailed referral form, designed to capture all essential information for psychological evaluation and intervention planning.

• Student & Referrer Details – Basic information and contact data
• Referral Reason – Specific concerns and duration
• Academic & Behavioral Profile – Performance data and observations
• Social-Emotional Assessment – Peer relationships and coping skills
• Background Factors – Family, medical, and service history
• Intervention History – Previous strategies and outcomes
• Parental Involvement – Notification status and consent
• Evaluation Priority – Urgency level and desired outcomes
• Psychologist Section – Actions taken and recommendations

Essential for teachers, school counselors, and special education teams needing structured documentation to initiate student support services and evaluations.