GoodLife | Psychological Services

Developmental / Behavioral Assessment

SPED IQ Testing Registration

Child Information

First Name *

Middle Name

Last Name *

Suffix (e.g., Jr.)

Nickname

Date of Birth * (MM / DD / YYYY)

Age *

Gender *

School

Grade / Year Level

Assessment Info

Assessment Type *

Testing Center / Branch *

Referral Source

School Batch ID (Leave blank if individual)

Guardian Information

The guardian will use this account to log in and fill out the intake form. No separate account is created for the parent/guardian.

Guardian Full Name

Relationship to Child

Create Login Credentials

Note: The username and password should be the same

Example:
Username: Cruz1999
Password: Cruz1999

Username *

Password *

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