Neuropsychological Assessment Referral

Date/Time
Is the child between the ages of 3 and 17?
Has the child graduated high school?
Did the child live, work, or attend day care/school in the city of Flint or surrounding areas anytime between April 2014 until September 2021?
Does the child currently live in Genesee County?
Does the child have Medicaid?
Gender
Hispanic/Latino Origin:

If submitting by fax, please fax referral sheet, along with any other documents (school records/IEP, psychological evaluations, previous medical evaluations such as from neurologist, etc.) that may be of benefit to assist in the evaluation process to (810)257-3757. Thank you.

GHS Neurodevelopmental Center of Excellence
2700 Robert T. Longway, Suite H
Flint, MI 48503
Phone: (810) 496-5677
Fax: (810) 257-3757

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