DHS Child Evaluation RequestOnline Form


Children's Program DHS PortalWeb link

Please note:

  • At the present time we are unable to accept referrals for children nine and older when the concern is autism/ASD.
  • Additionally, we do not accept referrals for stand-alone interaction studies.
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    Attention caseworkers, starting 5/31/2023: Evaluation referrals are still being accepted, but we will not be processing/scheduling them until June 12th. We are trying to clear up a back log of paperwork at the moment. Thank you for your patience!

    You will notice our referral form has been modified and updated. We have changed it to make it easier for everyone!

    DHS referrals are now a 2-step process:

    1. For each referral, please request authorization for the following billing codes:
      • 90791
      • 96130
      • 96131
      • 96136
      • 96137
    2. Most important: We are now requiring the consents and the caseworker’s referral letter to be submitted at the time of the initial referral. The referral will not be considered complete without these documents and the requested appointments will not be scheduled until it is complete.

    This will eliminate the need for reminder emails and phone calls looking for paperwork, so that once the referral has been submitted all that you, the caseworker, will have to do is confirm the appointments and be available for the initial consult call.

    The portal will still be open for collateral information.Please let me know if you have any questions or comments. I can be reached at mwood@childrensprogram.com

    We provide complete psychological evaluations for children up to 18 years of age who are in DHS custody/guardianship.

    We will complete parent/child and/or sibling interactions in the context of a full psychological evaluation on a child.

    To initiate a psychological evaluation at the Children’s Program, complete the appropriate online form listed on the left. A new form must be submitted for each person to be evaluated.

    You will be contacted with a tentative date/time for the evaluation.  Please confirm the appointment via email. Upon confirmation, you will be linked to the child in the DHS portal so you can add any collateral information deemed relevant.

    If you have any questions about completing these forms, please e-mail DHSinfo@childrensprogram.com.