Intake Form

Parents often seek evaluations when a child is struggling academically, showing signs of attention or learning difficulties, experiencing emotional or behavioral changes, or when a diagnosis like ADHD, anxiety, or autism is suspected or needs clarification. Evaluations are also helpful during key school transitions or when previous testing has not fully explained a child’s difficulties. If you feel something isn’t adding up, a neuropsychological evaluation provides clarity and direction.

The evaluation includes an interview with parents, a detailed review of developmental and educational history, direct testing with your child, and input from teachers when appropriate. Children engage in a variety of tasks that measure memory, attention, learning, language, problem-solving, and emotional functioning. After testing, Dr. Rossini provides a detailed written report and a feedback session that explains results in clear, practical terms, along with tailored recommendations you can use at home and at school.

You will receive a comprehensive report with individualized, evidence-based recommendations to support your child’s learning, behavior, emotional growth, and overall well-being. These recommendations may include strategies for home and school, classroom accommodations, referrals for therapeutic services, suggestions for specialized tutoring, or guidance for IEP and 504 planning. Many families use the report to advocate for school services or to coordinate care with medical and mental health professionals.

Yes. Collaboration is a key part of the process. With your permission, Dr. Rossini communicates with teachers, school teams, pediatricians, therapists, or specialists to ensure that everyone supporting your child understands the evaluation findings and recommended interventions. This coordinated approach helps your child receive consistent, effective support across all environments—home, school, and the community.

Rossini Pediatric Neuropsychology is an out-of-network provider and does not bill
insurance directly. You are responsible for full payment regardless of reimbursement. A detailed receipt will be provided for potential insurance submission.

An evaluation from Rossini Pediatric Neuropsychology offers personalized
recommendations tailored to meet a child’s specific needs. Parents receive detailed feedback and practical strategies that can be immediately implemented by the child’s
team, both inside and outside of school. Dr. Rossini completes the entire evaluation and
feedback process within one week. After the parent feedback session, parents get a
comprehensive written report within 2 to 3 weeks. Recommendations and treatment
planning may include ways to support learning, strategies for building emotional
resilience, and guidance for parents on accessing academic instruction,
accommodations, special education services, or therapeutic interventions. Additionally, the evaluation provides the documentation often necessary to advocate effectively for services within schools and healthcare systems.

In accordance with 225 ILCS 107/55, all fees, billing procedures, and payment
expectations will be disclosed in writing prior to the start of services. Comprehensive Evaluation: $4,200 (flat fee). Includes record review, testing, scoring, interpretation, feedback, report writing, and recommendations.

Payment
Full payment is due at the first appointment. Accepted forms: cash, check, Zelle, Visa,
MasterCard, Discover (no AmEx). Cancellations with less than 7 days’ notice → $200
fee. Unpaid balances after 30 days may be referred to collections.
Other Services (billed at $300/hour):
1. School visits
2. Attendance at IEP/504 meetings
3. IEP preparation or review
4. Individualized consultations or expert opinions
5. Supplementary letters or reports
6. Legal matters (preparation and attendance time billed door-to-door)

Download the Release of Information (ROI) form.